DVX APPLICATION 2018-19
Email address *
STUDENT FIRST NAME *
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STUDENT LAST NAME *
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PERMANENT STREET ADDRESS *
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ZIP CODE *
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STUDENT CELL PHONE NUMBER *
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PARENT CELL PHONE NUMBER *
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STUDENT EMAIL *
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PARENT EMAIL *
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NAME OF PARENTS / GUARDIANS *
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SEX *
Birthday
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NAME OF HIGH SCHOOL *
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CURRENT HIGH SCHOOL COUNSELOR *
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COLLEGE ACCEPTANCES *
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SCHOLARSHIP OR FINANCIAL AID AWARDS *
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EXTRACURRICULAR ACTIVITIES
LEADERSHIP AND INVOLVEMENT
LIST MEANINGFUL ACTIVITIES AND ORGANIZATIONS IN WHICH YOU HAVE PARTICIPATED IN HIGH SCHOOL. INDICATE YOUR LEVEL OF INVOLVEMENT. *
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INDICATE ANY SPECIAL RECOGNITION YOU HAVE RECEIVED FOR ACADEMICS OR EXTRACURRICULAR ACTIVITIES: *
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COMMUNITY SERVICE
LIST COMMUNITY SERVICE OR SERVICE LEARNING IN WHICH YOU HAVE BEEN INVOLVED AND INDICATE YOUR LEVEL AND DURATION OF INVOLVEMENT AND ANY SPECIAL ACCOMPLISHMENTS: *
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COLLEGE COURSES
LIST ANY PAST COLLEGE CLASSES YOU HAVE TAKEN AND PASSED WITH A "C" OR BETTER: *
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WORK EXPERIENCE
JOB TITLE, DESCRIPTION AND HOURS PER WEEK. HOW LONG HAVE YOU HELD THE JOB? *
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To monitor compliance with civil rights legislation, federal and state agencies require universities to describe their racial/ethnic populations. Your response to the following will assist our efforts to ensure compliance. Please check the category that best describes your racial/ethnic background (optional). Please check all categories that you identify with.
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Required
DO YOU QUALIFY FOR FREE AND REDUCED LUNCH? *
WERE YOU BORN IN THE United States?
STUDENT SIGNATURE: _______________________ *
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PARENT SIGNATURE: ________________________ *
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OPTIONAL: In approximately 500 words, describe what you expect to gain from joining DVX. How does this program align with your goals? What should we know about you? How will you contribute to DVX?
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