What school do you attend?
Grade level
Are you currently being served by another Federal Program? (Check all that apply)
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Have you taken a STARR test?
 As of this school year which of the following English courses have you completed. Check all that apply.
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As of this school year which of the following Math courses have you completed. Check all that apply.
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As of this school year which of the following Science courses have you completed. Check all that apply.
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As of this school year which of the following Social Studies courses have you completed. Check all that apply.
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What do you plan to do after graduating high school?
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Have you taken any of the following tests, what was your score? Check all that apply 
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What type of degree do you plan to obtain? (Check all that apply)
Are you interested in getting additional support during college from a Student Support Services and/or similar program?
What Talent Search services are you interested in receiving? (Select all that apply)
I am interested interested in referrals to tutoring services for the following core subjects (Check all that apply)
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Student Agreement Statement:
I, the student, agree that by enrolling in this program:
•I plan to enroll in a rigorous secondary program of study at my high school.
•I plan to enroll in a postsecondary education program (attend college or university).
•I will inform my advisor if my plans after high school change.
•I will inform my advisor if my class schedule changes.
•I will inform my advisor if my contact information changes (mailing address, phone number, e-mail, etc.).
•I am expected to attend a minimum of two (2) activities per semester.
•I will follow up in a timely manner with my advisor if they send a notification for me.
•I will maintain a minimum GPA (grade point average) that will allow me to apply to the college of my choice.
I understand this program is a voluntary program and that my guardian(s) or I can elect to withdrawal from the program at any time. I understand I am expected to participate in the program and understand that a lack of participation is grounds for exit of the program.