Educational Talent Search Academic Plan

Name

First NameLast Name

Email

example@example.com

Phone Number

Area CodePhone Number

Date of Birth

MonthDayYear

Address

Street Address

Street Address Line 2

CityState

Zip Code

What high school do you attend?

What grade are you currently in?

Would like help discussing a plan for your high school courses?

What colleges or universities are you considering to attend?

I plan to attend college for ___ years.

What careers are you considering?

Would you like help learning more about careers you're interested in?

By the end of this school year, I would like my grades to be...

I would like information about the following. Check all that apply.

You selected Study Skills above, is there a particular subject you need help studying for?

Signature

Today's Date

MonthDayYear

Significant effort has been made to ensure this content meets accessibility guidelines. If you encounter a barrier you can report the barrier at midmich.edu/reportaccessibilitybarrier or contact Educational Talent Search at (989) 386-6622 x529 or mkujat@midmich.edu.

In its commitment to providing a safe environment, Mid Michigan College actively endeavors to broaden our diversity, promote equal opportunity, and prohibit any form of discrimination in its programs, activities, and conditions of admission or employment. Learn more about these efforts and policies by visiting midmich.edu/eeo, midmich.edu/titleix, midmich.edu/securityreport.