Free Minds Application
We are accepting applications for the Free Minds Class of 2019-20! The class begins in mid-August 2019.

Interested in participating in Free Minds? You are eligible if you:

* Are at least 18 years old
* Have a high school diploma or GED
* Do not yet have a college degree
* Have not been enrolled in a degree-seeking program within the past two years
* Have demonstrated financial need (income not exceeding $42,000 for a single adult or $60,000 for a family of four)
* Are able to read challenging books in English
* Make a commitment to attend class regularly and complete all assignments

To be considered for the 2019-20 Free Minds class, please complete and submit your application no later than Monday, July 8, 2019. Applications will be reviewed to determine if your needs match the program’s goals. Applicants under consideration will be contacted in July.

For more detailed information, visit

Please fill out the form by answering each question appropriately. This application will ask questions about your education background and income, and you’ll be required to submit a brief, 300 word personal statement at the end.

Section 1 - Personal Contact Information
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
Street Address *
Your answer
Street Address (continued)
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Primary Phone *
Your answer
Other Phone
Your answer
Email Address *
Your answer
Section 2 - Questions
Please keep answers brief. (2-5 sentences for each.)
What do you like to read? Discuss something you’ve read and appreciated in the past. How did this impact you? *
Your answer
What do you hope to learn or achieve in Free Minds? Write at least three sentences that begin with the words, "In this course, I want to..." *
Your answer
What will you need to do to accomplish the goals you've listed above? Discuss the challenges you expect to face. *
Your answer
Section 3 - Additional Demographic Information
The demographic information you provide is strictly confidential and used internally for reporting purposes. Free Minds does not discriminate in regard to race, color, creed, national origin, religion, age, gender, sexual orientation, political affiliation, or disability.
Date of Birth *
Racial background/Ethnicity
Optional: What is your race or ethnicity as you define it? Check all that apply:
Which of the following describes your education? *
What year did you earn your high school diploma or GED? *
Your answer
Have you attended college before? *
If yes, what college(s) did you attend?
Your answer
If you've attended, how long have you been out of college?
If you've attended college, what year did you last attend?
Your answer
If you've attended college, why did you stop?
Your answer
How many college credit hours have you earned? It's okay to estimate.
What is your employment status? *
If employed, what is the name of your organization/employer?
Your answer
What is your annual household income before taxes (including you, your spouse/partner, and your children)? Note: To be eligible for Free Minds, you must demonstrate financial need (income of no more than $42,150 for a single adult or $60,200 for a family of four). *
Your answer
How many children (under 18) are living in the household? *
What are their ages?
How many people reside in your household? (Please include spouses or partners, children, and other family members.) *
Your answer
Do you or anyone in your household receive any public benefits? *
If yes, which public benefits do you receive? Mark all that apply.
If other public benefit:
Your answer
Do you live in a Foundation Communities property? *
Apartment complex
How did you hear about Free Minds? (Please be as specific as possible. List the name of the referring organization, the place where you saw the information, or the person who told you about the program.) *
Your answer
Personal Statement *
Please write a one page (300-500 word) statement describing yourself, your interests and goals, and why you would like to be part of the Free Minds class. Discuss how you would contribute to the class and what you want to do or be able to do after completing it. Your application will not be considered without a written statement. If you are submitting a paper application, your statement may be handwritten or typed.
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service