Apply Form | First Gen Success

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Student Full Name

Date Of Birth

Address

City

State

Zip Code

Country

Student Email

Student Phone

Ethnicity

Parent(s)/ Guardians(s) Name(s)

Parent(s)/ Guardians(s) Phone

Parent(s)/ Guardians(s) Email

Education

high school

From

Address

Grade Level

Expected Year of Graduation

Character References Person One

Personal References Please list the names, addresses, and phone numbers of three people you would like to use as character references (only people you have known for at least a year). Any information First Gen Success Program gathers from these references will be held as confidential and not released to you, the applicant. Relative’s Name

Enter Name

Phone

Address

Relationship

How Long known

Character References Person Two

Personal References Please list the names, addresses, and phone numbers of three people you would like to use as character references (only people you have known for at least a year). Include at least one relative. Any information New Insights Mentoring Program gathers from these references will be held as confidential and not released to you, the applicant. Relative’s Name

Enter Name

Phone

Address

Relationship

How Long known

Date

Mentor Wish list

1. Please describe your ideal Mentor. (Examples: good listener, able to give constructive feedback, honest and candid, energetic, experienced, etc.)

2. What do you hope to gain from your mentor experience? List three things you would like your mentor to provide. (Examples: choosing a major, help with classes, getting acquainted with school, study abroad advice, internship/full-time advice)

3. List your future goals (college and professional) (List at least 3).

5. Is there anything else you would like us to know about you that will help us make a good match?

Mentor Wish list

In 400-500 words please answer the following: Discuss an accomplishment, event, or realization that sparked a period of personal growth and a new understanding of yourself or others.

Ethnicity

Education

Character References Person One

Character References Person Two

Mentor Wish list

Mentor Wish list

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