COL Alpha Project 2025 Application

This is the form for the ALPHA Project 2025 for CO Lynchburg. If you are with another CO region, this is NOT the correct form. Please contact your campus staff for the correct application.
Alpha Project 2025 Application

Thank you for considering the Campus Outreach Alpha Project. This form should take you approximately 15 minutes to complete.
Important Dates:

Application Deadline: March 31st

Commitment Form Due: April 11th

Alpha Project Dates: May 12th - May 30th

Acceptance is rolling and space is limited.
Part I: Bio Information
Full Name*

Your First NameYour Last Name
Gender:*
School*
Year*
Major:*
Anticipated Graduation Date:*

Grad MonthGrad DayGrad Year
E-mail:*
Cell Phone:*

Cell Area CodeCell Number
Parent/Guardian's Name(s)*

P/G First Name(s)P/G Last Name(s)
Parent/Guardian's Phone:*

P/G Area CodeP/G Number
Do you consistently take any medications or prescriptions?*

YesNo
Are you currently being treated for any psychological or physical conditions?*

YesNo
Please explain below if necessary.
By checking "Yes" you do not disqualify yourself from the Alpha Project. By checking "Yes" you do give our Executive Project Director and Regional Director permission to reach out if necessary to ask for more information. All of your answers are confidential and privy only to the Project Director and Campus Outreach DC/Lynchburg Regional Director.

Alpha Project 2025 Application

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