Yale-Bridgeport GEAR UP Class of 2017
College Scholarship Application


APPLICATION

PLEASE NOTE: As part of this application, you will be required to upload supporting documents, such as High School transcript, essay, and academic resume. These documents must be uploaded at the time you submit this application - the application cannot be completed without uploading these documents! See the previous page for a full list of required documents (note: you are not required to upload a list of colleges and universities to which the student has applied, or a list of employment, internship and/or extracurricular activities in which the student has participated, because you will enter this information directly into fields in the application form below). Documents may be in the form of MS Word, Excel or PowerPoint, PDF, and/or plain or rich text files.

Note: required fields are marked *

 

Student information

   
First Name: *
Last Name: *
Date of Birth: *
High School: *
Street Address: *
City: *
State: *
Zip: *
Home Phone:
Cell Phone:
E-mail address: *
 

Parent information

   
First Name: *
Last Name: *
Street Address: *
City: *
State: *
Zip: *
Home Phone:
Cell Phone: *
Work Phone:
E-mail address: *
Highest level of education: *
 

Family information

   
Are there any other members of your household who will also be attending college in the fall of 2017? *  Yes      No
   If yes, who?
   Relationship to student:
   Person's expected graduation date:
Will you be the first person in your family to graduate from college? *  Yes      No
 

COLLEGES AND UNIVERSITIES TO WHICH STUDENT HAS APPLIED

   
Have you made a final decision about which college you will attend? *  Yes      No
   If yes, which school?
   
Colleges and Universities to which you've applied: *  
Name of School City State Were you accepted yet?
 Yes      No
 Yes      No
 Yes      No
 Yes      No
 Yes      No
 Yes      No
 

EMPLOYMENT, INTERNSHIP AND/OR EXTRACURRICULAR ACTIVITIES STUDENT HAS PARTICIPATED IN *

Activity Date (s) Role Description
 

Disclosure Statement

By checking the boxes below, we agree to provide the Yale-Bridgeport GEAR UP Partnership with copies of the student’s college transcripts for the fall 2017 semester and the spring 2018 semester.
 Student agrees to the disclosure statement *
 Parent agrees to the disclosure statement *
 
     NOTE: you will be required to upload supporting files on the next page.