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Participant Application
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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:
*
Male
Female
*
US Citizen:
yes
*
no
*
Ethnicity:
*
African American
*
Asian
*
Latino
*
Native American
White
Other / Please Specify:
*
Student's Email:
*
Sibling(s) in the program:
*
yes
no
Student School ID Number:
School Information
*
Name of School Presently Attending:
*
Year in School:
6th
*
7th
*
8th
*
9th
*
10th
*
11th
*
12th
*
Year of Expected High School Graduation:
*
Current GPA:
Student's School Counselor's Name:
*
Are you currently employed:
*
yes
no
*
If yes, place of Employment:
*
Are you planning to continue with your education beyond high school:
*
yes
no
Why or Why not?:
Are you interested in attending a local community college?:
yes
no
*
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?:
*
yes
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:
*
yes
no
*
Has your mother received a Bachelor's Degree from a U.S. College or University:
*
yes
no
*
Has your father served in the military:
*
yes
no
*
Has your mother served in the military:
*
yes
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
