| Student Name: |
Email Address: |
| Home Address: |
City: |
Zip Code: |
| Home Phone#: |
Work Phone#: |
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| Date of Birth: |
Gender: Male Female |
| Language Spoken at Home: |
Ethnicity (optional): |
| Current School: |
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| I. BACKGROUND |
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| Are you the first person in your family to go to college? |
Yes |
No |
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| Have you applied for any financial aid? For example: Grants, Loans, Work Study or Scholarships |
Yes |
No |
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| Are you planning to work while attending college? If so, how many hours per week? |
Yes |
No |
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| Can you take classes in the morning? (8:00 a.m.-12:00p.m.) |
Yes |
No |
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| If you checked "No", can you only take classes in the evening? (5:00a.m.-10:00 p.m.) |
Yes |
No |
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| Do you want more information about the following? Check all that interest you) |
| Financial Support |
How to Set Goals |
How to Improve Study Skills |
Student Success |
| Clubs & Organizations |
Career Exploration |
Time Management |
College Major or Interest |
| Personal/Family Issues |
College Resources |
Transfer to University |
Motivation |
| College Policies |
Self-Confidence |
Stress Management |
Child Care |
| Other: |
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| I. GOALS |
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| Do you plan to tranfer to a four-year university? |
Yes |
No |
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| If yes, which universities interest you? |
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| If you could choose three careers, what would they be? |
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AGREEMENT
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| If I am accepted into the FIRST YEAR EXPERIENCE program, I will commit myself to the following: |
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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. |
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