Mt. San Antonio College RISING SCHOLARS Program Interest Form

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Please take the time to fill out this form if you are interested in joining the RISING SCHOLARS program at Mt. San Antonio College. Once you have filled this out we will be in contact with you shortly. Thank you for your interest. If you have any question you can call (909) 274-5808.

First & Last Name *

Birthdate *

YYYY

Email *

Phone Number *

What is the best way to contact you *

Phone Call

Text

Required

Do you have a High School Diploma or a G.E.D. *

Yes

Are you currently on any of the or have you been on following? *

Parole

Probation (adulty felony probation)

AB109

Federal Parole

Summary Probation

Youth Probation

Open Case

No longer on probation or parole

Not Applicable

Required

Can you please provide us with any of the following information X number, probation or parole officer's name, Public Defenders' name?

Who referred you to the RISING SCHOLARS program? *

Five Keys

Probation Officer

Parole officer

Treatment center

Mt.SAC Staff or Faculty

Homeboy Industries

Drug Treatment Center

AJCC

Public Defenders Office

Rising Scholars Staff

Mt. SAC Application

Youth Probation Officer

What is your student status *

Already a Mt. SAC student

New Student (never been to college)

New Student (attended college before)

Returning after a break

Submit

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