Summer GOALS Program Application

Summer Goals Program Application

Student Support Services - Mars Hill University
Personal Information
Name

First NameLast Name
Student ID
Birth date
Email (that you check regularly)
example@example.com
Phone Number
Please enter a valid phone number.
Gender

MaleFemale
Marital Status

SingleMarried
Home Information
Name of Parent(s)/Guardian(s)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Academic Status

FreshmanSophomoreJuniorSenior
Desired Major
Race

WhiteBlack/African AmericanAsianAmerican Indian or Alaskan NativeNative American or Pacific Islander
Ethnicity

Hispanic or LatinoNon Hispanic or Latino
Resident Status

US CitizenTerritory ResidentPermanent VisaResident Alien
Eligibility Information
With whom have you lived during the past year? (This is the person who claims you on income tax forms)

FatherMotherFather AND MotherGrandparent(s)GuardianSpouseI am self-supporting
Has your mother GRADUATED from a 4-year college?

YesNo
Has your father GRADUATED from a 4-year college?

YesNo
Do you have a disability that you wish to disclose?

YesNo
If so, is it DOCUMENTED (on file) at MHU?

YesNo
Educational Background
High School
Graduation Date
What were your best subjects in high school?
What were your worst subjects in high school?
Do you have Early College, Dual Enrollment, Transfer and/or College Board hours you will be bringing to MHU?

YesNo
Transfer Student
College/University
Do you need accommodations (academic and/or housing) for a documented disability?

YesNo
If yes, please specify on the line below and please mail/email documentation with your GOALS application.
Why do you want to go to college?
Why would you like to attend MHU Summer GOALS Program?
I agree that the Student Support Services Office may access any of my records stored at the University for determining my program eligibility and/or for advertising. I further agree that the information provided is true and accurate to the best of my knowledge. I hereby give my permission to the Student Support Services staff to release pertinent information in my file to faculty members of the professional staff if the Student Support Services office determines that doing so is in my best personal and/or academic interest.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Summer Goals Program Application

Personal Information

Home Information

Eligibility Information

Educational Background