First Name:

Last Name:

Date of Birth

Parents Information:

Mentor Information:

Education:

Individualized Educational Plan (IEP)

Social economic disadvantage (SED) Low Income

Do You Wish to Go to College?

Have you applied to any colleges?

Have you applied for Financial Aid or a Grant?

Do you have a criminal record?

California ID

California Driver's Permit

California Driver License

Do You Have A Resume?

Have Ever Had a Job Interview?

Do you know how to dress for a interview?

Bank Account Checking

Savings

Job