Candidate Student Application
Apply for a College Technology Readiness Kit
Section 1: Applicant Information
Name
*
First Name
Last Name
Date of Birth:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Pronouns (optional):
Email Address:
*
example@example.com
Phone Number:
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Section 2: Educational Information
Current High School Attending:
*
Expected High School Graduation Year:
*
College/University You Plan to Attend:
*
Planned Major or Area of Interest (if known):
Expected College Start Date (Month/Year):
*
Section 3: Technology Access & Need
Please select the option that best describes your current access to technology (check all that apply):
Technology Access Options
*
I do not own a personal laptop or computer
I share a computer with family members
My computer is outdated or unreliable
I rely on public or school computers
I do not have consistent internet access at home
Other
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Section 4: Financial Need & Circumstances
Please briefly describe your financial situation and why receiving a College Technology Readiness Kit would support your success in college.(300-500 words recommended)
*
Section 5: Personal Statement
In your own words, tell us: What does college success mean to you?How will access to reliable technology help you reach your academic and career goals?(300-500 words recommended)
*
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Section 6: Referral (Optional)
Were you referred to The CREW Project by a community organization, school, or trusted partner?
Were you referred to The CREW Project by a community organization, school, or trusted partner?
*
Yes
No
If yes, please provide referral information:
Referring Organization or Individual:
*
Contact Name:
*
Title
*
Email/Phone:
*
Section 7: Applicant Certification
By signing below, I certify that:
The information provided is true and accurate to the best of my knowledge
I understand that selection is competitive and based on demonstrated need
I agree to allow The CREW Project to verify enrollment if selected
Applicant Signature:
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Referral Signature:
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
***Office use only***
***Office use only***
Rows
Reviewed by
Interviewed by
Approved By
Approval Date
1
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