U2 Scholars - Program Application-1

Personal Information

SAC ID

First Name *

Middle Name (or initial)

Last Name *

Date of Birth *

Date

Gender *

Contact Information

Address

City

State

Zip Code

Email

example@example.com

Confirm Email

example@example.com

Home Phone

Cell Phone *

Ethnic Background

Select the ethnic background category you most identify with:

Please specify your ethnic background:

Is a language other than English spoken regularly in your home?

Yes No

If yes, specify

Residential Status

Citizenship or Visa Status (check one)

Academic Information

Enrollment status (check all that apply): *

New to college Continuing Transfer (from another college) Full time: (12 units) Part time: (6 units or less)

1st semester enrolled at SAC; if applicable (give the semester and year)

ex. fall 2018

Current College Counselor

Total number of college units completed *

Current College Cumulative GPA

Declared Major

Educational Goal

Career Interest/Goal

Intended Transfer College(s) - in order of preference:

1.

2.

3.

Upload SAC Unofficial Transcript

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Previous school(s) attended:

High School

Graduation Date

Date

College

Last Attended Date

Date

College

Last Attended Date

Date

Challenges that may interfere with your education (check all that apply): *

Navigating the educational system Family obligations Financial need Employment issues Exceptional needs (specify what these needs are below) Other challenges (specify what these needs are below)

Other Challenges

Exceptional Needs

Are you employed?

Yes No

If yes, how many hours per week?

Are you a veteran?

Yes No

If yes, which branch?

Parent/Guardian Infomation:

Highest level of education achieved by each of your parents/guardians:

Father/Guardian

Mother/Guardian

U2 Scholars Program Application