Participant Application

PRE-COLLEGIATE DEVELOPMENT PROGRAMS
Colorado Springs Participant Application
Student Information
*Last Name:
*First Name:
*Middle Initial:
*Mailing Address:
*City:
*State:
*Zip Code:
*Home Phone Student:
Student Cell Phone:
*Student Birth Date:
*Gender: * Female
*US Citizen: * no
*Ethnicity: *
* Native American White
Other / Please Specify:
*Student's Email:
*Sibling(s) in the program: *
Student School ID Number:
School Information
*Name of School Presently Attending:
*Year in School:
*Year of Expected High School Graduation:
*Current GPA:
Student's School Counselor's Name:
*Are you currently employed: *
*If yes, place of Employment:
*Are you planning to continue with your education beyond high school: *
Why or Why not?:
Are you interested in attending a local community college?:
*Where are you planning to apply to college after your graduation from high school option 1:
*Where are you planning to apply to college after your graduation from high school option 2:
*Where are you planning to apply to college after your graduation from high school option 3:
*Where are you planning to apply to college after your graduation from high school option 4:
*What is your planned major / minor? (accounting, teaching, law, biology, etc...):
Parent(s) / Guardian(s) Information
Name of Mother or Female Guardian:
Name of Father or Male Guardian:
*Are the mailing address and phone number the same as the student's?: * no
Mailing Address:
City:
State:
Zip Code:
Phone:
*Parents E-Mail 1:
Parents E-Mail 2:
*Total number in your Family:
*Total number in your Household:
*Highest Grade Completed by Father:
*Highest Grade Completed by Mother:
*Has your father received a Bachelor's Degree from a U.S. College or University: * no
*Has your mother received a Bachelor's Degree from a U.S. College or University: *
*Has your father served in the military: * no
*Has your mother served in the military: * no
*Father's Occupation:
*Mother's Occupation:
*I certify that the above information is true to the best of my knowledge.
*
Validation Code
[?]
* denotes required field