ApplicationFor the questions below, please fill out the information based on the applicant. If you are the legal guardian of the applicant, you will be asked to fill out a seperate part of the application for your own information. Legal Name: _____________________________________________________ Date of Birth: _____________________________________________________ Male/Female: _________ Telephone Number: (___)-_____-______ Home Address: _____________________________________________________ _________________________________________________________________ Mailing Address (If not same as home address): __________________________________________ _________________________________________________________________ Are you applying for yourself, or a child you are the legal guardian of?: _____________________
If you are a legal guardian applying for a child, please fill out the following section: Legal Name: _____________________________________________________ Date of Birth: _____________________________________________________ Male/Female: _________ Telephone Number: (___)-_____-______ Home Address: _____________________________________________________ _________________________________________________________________ Mailing Address (If not same as home address): __________________________________________ _________________________________________________________________ Are you applying for yourself, or a child you are the legal guardian of?: _____________________ ----------------------------------------------------------------------------------------------------------------------------------------------------------------- Program you are Applying for (Elementary, Middle School, High School, College, Post-Graduate): _________________________ Academic Interests (If High School or Higher): _________________________________ Career Interests (If College or Higher): _______________________________________ Past Educational Experience: ______________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Do you need information about financial aid opportunities?: ______________ ----------------------------------------------------------------------------------------------------------------------------------------------------------------- Are you Empowered? ________________ If yes, please briefly explain the nature of your abilities (Basic function, triggers, etc.): _____________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________
Please send in answers to these questions along with an educational resume (And career resume, if applicable). After initial review, you will be contacted with additional information based on the answered you have provided as well as being contacted for an interview if necessary. |