2019-2020 Core College Application
Thank you for your application. Please note that your application will not be processed until the $36 non-refundable application fee is received. Once your application is reviewed you will be sent a notification status. Please contact us at firstname.lastname@example.org or 313-473-0787 with any questions. Thank you!
Date of Birth
Date Picker Icon
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
High School Name:
Grade in Fall 2019
Are you Hispanic, Latina or Latino?
No, not Hispanic, Latina or Latino
Hispanic, Latina or Latino
Student Phone Number:
Student Email Address:
Select one or more of the following racial categories to describe yourself?
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Please list any special needs:
Parent/Guardian Phone Number:
Parent/Guardian Email Address:
Participant Code of Conduct
Core Elements Higher Education Resource Center is invested in offering a dynamic learning environment to all participants. All members of the core community are entitled to participant in an environment free from threat, discrimination, and other harmful acts. As such, there is an expectation that all members of the community (faculty, staff, students, parents) are treated with dignity and respect. Participants are admitted to Core Elements Higher Education Resource Center’s programs with the understanding that they will fully participate in the program and activities. The use of cellphones and/or other electronic devices are not allowed during course sessions without permission from the facilitator. For students to maximize their learning experience in the program, attendance is essential. Students with multiple unexcused absences will be removed from the program.
Core Elements Higher Education Resource Center: Release of Information to Authorized Persons/Organizations
I consent to allow Core Elements Higher Education Resource Center release information regarding the student participant in the Core College Program. This may include name, hometown, high school attended and/or graduated from and information relating to any financial aid awarded during attendance at any higher education institution, major, and program information such as general location or term. I understand that information collected may be used for organizational research purposes. I understand non-consent does not affect my participation in the program. I understand only a summative of this information would be shared publicly (no individual identifiable characteristics would be released). I understand the data will be used to track trends, help determine new program offerings, request grant funding, and so forth. I understand Core Elements Higher Education Resource Center monitors the progress of students who participated in the program to better evaluate the effectiveness of the Core College Program in light of its mission and vision. As part of the monitoring process, aggregated information may be shared that does not include my Personal Information and may otherwise disclose non-identifying information with third parties for analysis, demographic profiling and other purposes. Any aggregated information shared in these contexts will not contain student personal Information. I understand that Core Elements Higher Education Resource Center will take appropriate steps designed to secure and protect the information provided, to keep it confidential, and to prevent others from connecting this data to the participant. To the extent possible, except as set forth in this form, any information that could identify me will be removed or changed before such information is shared with other researchers, organizations, or institutions and before any research results are made public in an aggregated form. Except as set forth in this form, under no circumstances will the participant identity and personal information be revealed by. This authorization will remain in effect until I revoke it, which I may do at any time by contacting Core Elements Higher Education Resource Center.
Core Elements Higher Education Resource Center: Photo, Video, & Sound Recording Release
By signing this Photo, Video and Sound Recording Release and Consent Form, you are irrevocably giving permission to Core Elements Higher Education Resource Center officers, agents, employees, successors, licensees, and assigns to take and use photographs, video or sound recordings of your child throughout their participation in the Core College Program. This is completely voluntary and up to you. Your consent to the use of the photographs, video and sound recordings and your child’s image, likeness, appearance, and voice is for forever. You will not receive compensation for the use of your child’s image, likeness, appearance, and voice now or in the future. Core Elements Higher Education Resource Center may use the photographs, video and sound recordings containing your child’s image, likeness, appearance and voice in any manner or media, including use on web pages. The photographs, video and sound recordings may be used in whole or in part, alone or with other recordings. The photographs, video and sound recordings may be used for any educational, institutional, scientific or informational purposes whatsoever, but not for any commercial uses. Core Elements Higher Education Resource Center has the right and may allow others outside the organization to copy, edit, alter, retouch, revise and otherwise change the photographs, video and sound recordings at the organization’s discretion. All right, title, and interest in the photographs, video and sound recordings belong solely to Core Elements Higher Education Resource Center. You further give permission to Core Elements Higher Education Resource Center to use your child’s name, biography, and any other personal data, events, or other material in or in connection with any such uses of the photographs, video and sound recordings. I understand and agree to the conditions outlined in this photograph, video and sound recording release and consent form. As the parent or legal guardian of the participant named below and on behalf of my child, I irrevocably give consent to Core Elements Higher Education Resource Center and the organization’s officers, agents, employees, successors, licensees, and assigns forever to make use of my child’s image, likeness, appearance, and voice in photographs, video and sound recordings as described above. I acknowledge that I am fully aware of the contents of this release and am under no disability, duress, or undue influence at the time of my signing of this instrument.
College & Career Readiness Program
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