NCCC Boost Application

NCCC Boost Application

Students should complete this form to apply for the NC Boost Program. *Required
Name*

Last NameMiddle InitialFirst Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Contact Email (required)*
example@example.com
Additional Contact Email (optional)
example@example.com
Date of Birth*

MonthDayYear
Gender*

FemaleMalePrefer not to say
Are you Hispanic or Latino?*

YesNoPrefer not to say
Race (Check all that apply)*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhitePrefer not to say
Have you completed your application to the college?*

YesNoI'm not sure
College Number ID: (If you have completed an application to the college.)
This should be your student ID number for the college, not a high school student ID number.
Current or intended Program of Study (i.e., your major)*
Have you completed a FAFSA form for this academic year?*

YesNoI'm not sure
How did you hear about the NC Boost program?*

Printed Flyer/Advertisement on CampusEmail/TextSocial Media PostCampus Faculty/StaffA friendOther
Why would you like to participate in the NC Boost program? (Check all that apply)*

Academic support the program providesIncentives the program providesCareer supports the program providesHaving a dedicated advisor to go toHaving a group to be a part ofKnowing someone is invested in my successOffered to people in my major/program of studyOther (Please explain below)
Please explain...
Please share additional information about why you would like to participate in NCBoost? You may consider sharing what drew you to the program, what do you hope to gain from participating in the program, and/or why you think the program may be important to helping you achieve your career goals.
Should be Empty: