2024-2025 High School to High Heels
Applicant Profile
Applicant Information
Student Name
*
First Name
Middle Name
Last Name
School
*
Grade Level
*
Age
*
T-Shirt Size
*
S
M
L
XL
XXL
XXXL
Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
County:
*
Cherokee
Cobb
Douglas
Paulding
North Fulton
Student must reside in one of the five counties (Cherokee, Cobb, Douglas, North Fulton and Paulding) served by Northwest Georgia Chapter.
Phone Number
*
Student's Email Address
*
example@example.com
Would you be comfortable with meeting in person?
*
Yes
No
Are you involved in any other mentoring programs?
*
Yes
No
Please upload a 2-3 minute video indicating why you are interested in participating in the High School to High Heels Mentoring Program and how this program would benefit you.
Browse Files
Max File Size: 10MB
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of
Upload Letter of Recommendation #1
Browse Files
Max File Size: 5MB
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Upload Letter of Recommendation #2
Browse Files
Max File Size: 5MB
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Extracurricular Activities including Employment
*
Enter N/A if none.
Describe any ideas of topics or activities you would like to see in this progam.
Parent/Guardian Information
Parent/Guardian #1 Name
*
First Name
Last Name
Parent/Guardian #1 Phone Number
*
Parent/Guardian #1 Email Address
*
example@example.com
Parent/Guardian #2 Name
First Name
Last Name
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Email Address
example@example.com
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Emergency Contact's Relationship to Student
*
By clicking 'YES' below, your parent/guardian is giving you permission to participate in the High School to High Heels program in addition to providing the National Coalition of 100 Black Women, Inc. - Northwest Georgia Chapter permission to use your photos for marketing, social media, etc.
*
Yes
No
Submit
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