The Zinniah Foundation

The Zinniah Foundation
Zinniah Foundation Program
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
Elementary SchoolMiddle SchoolHigh SchoolPost Secondary School
Date of Expected Graduation
African American/AfricanAsianCaribbean-AmericanHispanic/LatinoMiddle EasternNative AmericanWhiteOther
Guardian Information

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
About You

List school activites, jobs, community service, or leadership positions you feel are relative to you partaking in this program
List any special skills, talents, and/or interests
Please explain your plans after high school and/or future plans
Should be Empty: