GEAR UP for College Summer Program Application 2019

Student Information:

First Name *This question is required.

Last Name *This question is required.

Date of Birth *This question is required.

Street Address

Apt/Suite/Office

City

State

Zip

Phone Number

Mobile Phone *This question is required.

Email Address *This question is required. This question requires a valid email address.

GPA *This question is required.

High School You Attend *This question is required.

Please enter an 'other' value for this selection.

Current Grade *This question is required.

Student ID # *This question is required.

Parent/Guardian Information: *This question is required.

First Name

Last Name

Mobile Phone

Email Address This question requires a valid email address.

Does your child require transportation to the program?

Does your child need disability support services and accommodations? *This question is required.

Emergency Contact Information:

First Name

Last Name

Relationship to Student

Phone Number

Mobile Phone *This question is required.

1. Essay Question: Please write a short explanation for the following question (1-3 paragraphs):

What do you hope to gain by taking a college course this summer? *This question is required.

QUESTIONS OR MORE INFORMATION:
OHS – Brandon Hawkins • brandon.hawkins@oside.us • 760-901-8378
ECHS – Yasmine Willis Fernandez • yasmine.willis@oside.us • 760-901-8146

2. Student Signature

Clear

Signature of

3. Parent/Guardian Signature

Clear

Signature of

GEAR UP for College Summer Program Application 2019

Application Form: