2022-2023 Membership Application

Student Full Name *

First Name Last Name

Student E-mail *

Student Phone Number *

What is your preferred method of contact? *

Phone Call Text Email No preference

Home Address *

Street Address

Street Address Line 2

City State

Zip Code

Student Birth Date *

Month Day Year

What is your race? *

Indigenous American or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Are you Hispanic, Latino, or Latinx? *

Yes No

Country of Origin *

What is your family's country (countries) of origin?

Gender *

SCHOOL INFORMATION

Do you have a HoPe Chapter at your high school? *

Yes No

What high school do you attend? *

If "other," please list the high school you attend?

What is your grade for the 2022-2023 school year? *

What is you high school student ID? *

What is your Instagram Handle?

We would love to connect on IG! :)

MEMBERSHIP

The following questions refer to your choice of membership:

Regular Paid Membership: Access to all programming, t-shirt, and access to HoPe Cord.
Free Membership: Access to all programming.

If you have a HoPe Chapter at your school, you will pay your membership dues directly to your school.

If you do not have a HoPe Chapter at your school, you will pay your membership dues (if applicable) at the end of this application.

What membership are you interested in? *

Regular Paid Membership - $25 Free Membership - $0

T-shirt Size *

EDUCATIONAL

The following questions will help us provide you educational content and support.

Are you a First Generation college student? *

Will you (or your siblings) be the first in your family to attend college in the US?

Do you qualify for Free/Reduced Lunch? *

Where you ever a part of an English As A Second Learner program? (ESL/ESOL?EL) *

Do you currently have any education-related questions or concerns?

PARENT/LEGAL GUARDIAN INFORMATION

Parent/Guardian Name *

First Name Last Name

Parent/Guardian Email *

example@example.com or N/A

Parent/Guardian Number *

By signing below, you confirm you filled out this form in its entirety, and the information you provided is accurate to the best of your knowledge.

Student Signature: *

Typed name serves as your signature..

Parent/Guardian Signature: *

Typed name serves as your signature..

Thank you for submitting your HoPe Membership Application!

HoPe!

Breathe it! Live it! Love it!

2022-2023 HoPe Membership Application