Student Name: Email Address:
Home Address: City: Zip Code:
Home Phone#: Work Phone#:
Date of Birth:
Gender: Male
Language Spoken at Home:
Ethnicity (optional):
Current School:
I. BACKGROUND
Are you the first person in your family to go to college?
Yes
No
Have you applied for any financial aid? For example: Grants, Loans, Work Study or Scholarships
Yes
No
Are you planning to work while attending college? If so, how many hours per week?
Yes
No
Can you take classes in the morning? (8:00 a.m.-12:00p.m.)
Yes
No
If you checked "No", can you only take classes in the evening? (5:00a.m.-10:00 p.m.)
Yes
No
Do you want more information about the following? Check all that interest you)
Other:
I. GOALS
Do you plan to tranfer to a four-year university?
Yes
No
If yes, which universities interest you?
1.
2.
3.
If you could choose three careers, what would they be?
(Don't think about grades, skills, formal education or family resources at this time.)
1.
2.
3.
AGREEMENT
If I am accepted into the FIRST YEAR EXPERIENCE program, I will commit myself to the following:
Make my education a priority.
Do my best to complete the entire school year.
Take at least 2 classes per semester.
Make a real effort not to miss any classes.
Only drop a class after talking to my counselor.
Complete my class assignments as required.
Participate in occasional evening and Saturday programs.
