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MIDDLE SCHOOL INITIATIVE APPLICATION
The mission of ICA’s Middle School Initiative is to introduce middle school students to the importance of education, being actively involved and pursuing higher education. When application is complete, please have your parent/guardian sign.  
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First Name *
Last Name *
Date of Birth *
MM/DD/YYYY
Age *
Your current age
Gender *
Address
House #, Street/Ave, City, State, Zip Code
Email Address
Phone #:
XXX-XXX-XXXX
Name of School
What grade are you in?
6th, 7th, 8th, etc
Grade Average
How did you hear about the program?
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