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First Name
Last Name:
Age:
Date of Birth:
Grade/Undergraduate Year:
High School/University/College:
GPA:
Upload Your Transcript (.doc or .pdf)
Ethnicity (select all that apply):
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
White
Other
Other Ethnicity:
Mailing Address:
City, State, Zip Code:
Phone Number:
Email Address:
T-Shirt Size:
Small
Medium
Large
Extra Large
Extra- Extra Large
Emergency Contact Information (Parent/Legal Guardian)
Full Name:
Phone Number:
Email Address:
Essay Questions
Please attach your question responses to each question below
1. Attach your resume/CV. If you are a high school student and do not have a resume, reach out so that we can work with you to create one one.
2. What are your career/college goals? (
200-word max
)
3. Describe your ideal mentor. (
200-word max
)
4. What do you hope to gain from being a part of this program? (5
00-word max
)