College Bound Application

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Page 1

Please complete this application in entirety. The answers you provide will be kept between you and College Bound. If there are any spaces you are unable to complete, or if you have any questions about College Bound or the application process, please contact us at recruitment@collegeboundstl.org or via phone at 314-359-7154.

Student Information

Last Name

First Name

Middle Initial

Preferred Name

Home Phone (numbers only)

Cell Phone (numbers only)

Street Address

Apartment Number

City

State

Zip

Preferred Email Address

Ethnicity (This information is used only for statistical purposes and does not impact acceptance)

Gender Identity (This information is used only for statistical purposes and does not impact acceptance)

Please Specify

Preferred Pronouns

Birthdate

Do you have a relative in College Bound? If yes, please provide names:

How did you hear about College Bound?

Please Specify

School Information

Current High School

Current Grade Level

Counselor's Name

Anticipated Graduation Year

Enrolled in Special School District (SSD)?

Do you have an Individual Education Plan/IEP or receive special accommodations in your school?

Current Cumulative GPA (This information must be provided to be considered for the program and will be confirmed through your transcript.)

Unofficial Transcript

To confirm your GPA, we must receive a copy of your unofficial transcript. You can request your transcript from your school counselor or registrar.

If you are unable to retrieve your transcript, let us know.

Unofficial Transcript

Page 2

Interest/Experience

Tell us about the extracurricular, work experience, and volunteer activities you are currently involved in at school or in the community. Please include any honors/awards or leadership roles.

Please check the community organizations you are involved with or have been involved with in the past (This information is used only for statistical purposes and does not impact acceptance)

In each box, enter your career interest

Short Answer

Tell us about you

Tell us why you want to join College Bound.

How can College Bound help you meet your future goals in life?

Page 3

Family Information

Which caregivers live in the home?

Please specify

Mother Section

Mother's Last Name

Mother's First Name

Mother's Email Address

Mother's Cell Phone

Mother's Employer

Mother's Occupation

Highest Level of education completed

Father Section

Father's Last Name

Father's First Name

Father's Email

Father's Cell Phone

Father's Employer

Father's Occupation

Highest Level of education completed

Guardian Section

Guardian's Last Name

Guardian's First Name

Guardian's Email

Guardian's Cell Phone

Guardian's Relationship to Student

Is either parent (or have they ever been) incarcerated?
(This information is used only for statistical purposes and does not impact acceptance).

Total annual household income for the household in which the applicant lives a majority of the time: (This information must be completed in order to be considered and will be kept confidential.)

Total number of adults living in the household (18+)

Total number of children living in the household (under 18)

Does the household receive government assistance (SNAP, SSI, TANF, WIC, etc)?

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