2022-2023 Avenue Scholars Southwest Iowa Application
At Avenue Scholars Southwest Iowa (SWI), our mission is to provide educational and training opportunities for committed students through meaningful relationships and supportive coaching. Established in 2019, Avenue Scholars SWI is powered by the Avenue Scholars Foundation and the  Charles E. Lakin Foundation. The goal at our organization is to prepare students for a successful career in a variety of fields. Avenue Scholars SWI is a collaborative program that assists students with career exploration, selecting a career, and the education and training necessary for success in a career. Avenue Scholars SWI will introduce students in our program to a variety of quality career options in fields such as health services, information technology, auto tech & transportation, trades, manufacturing, & builders and business & office processes. The Avenue Scholars SWI team will coach these students through part-time work, thus providing them opportunities to experience the realities of the workforce as well as learn and develop the attributes necessary to be successful in it.

Students in the Avenue Scholars SWI program will work with career coaches and mentors in high school, during education and training in postsecondary settings, and on into the workforce. Avenue Scholars SWI will also provide support by means of a scholarship to continue their education/training after successfully completing their Avenue Scholars SWI high school experience.

Application Guidelines:
     -     All questions must be answered fully
     -     If a question does not apply to you or your family, please write "NA"

Note: Completion of the FAFSA (Free Application for Federal Student Aid) may be required

Email *
Student Personal Information
Please provide student personal information
Full Name: *
Preferred name if different from legal name
Student Preferred Pronouns *
Street Address: *
City: *
State: *
Zip Code: *
Student Phone Number: *
Student School Email: *
Student Personal Email:
Date of Birth: *
MM
/
DD
/
YYYY
Gender Identity: *
Shirt Size: *
First and Last Name(s) of Adult(s) with whom you live: *
How are these adults related to you: *
Student Academic Information
High School: *
Current Grade Level: *
Current GPA: *
I currently participate in the following clubs, activities, or athletics: *
Do you qualify for free or reduced lunch: *
Avenue Scholars SWI seeks to draw students from a variety of backgrounds. Please select to indicate in which group(s) you would include yourself: *
Required
Parent/Guardian Information
Please provide parent/guardian personal information
Full Parent/Guardian Name: *
Relationship to Student: *
Street Address: *
City: *
State: *
Zip Code: *
Home Phone Number: *
Cell Phone Number: *
Parent/Guardian Email: *
Consent to text: *
Our mission is to provide educational and training opportunities to motivated students in a variety of quality career fields. Please select a career option that interests you the most:
Health Services:
Trades, Manufacturing, & Builders:
Auto Tech & Transportation:
Information Technology:
Business and Office Processes:
Custom Programs: Have a trade or skilled job in mind but don't see it listed? Tell us! 
Disclaimer and E-Signature of Student
By providing my e-signature below, I certify that my answers are true and complete to the best of my knowledge
E-Signature of Student: *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy
Google Forms