2019 Fall College Edge Program Application
The College Edge Program is a comprehensive series of college-readiness workshops, SAT test preparation lessons, college tours, and private coaching sessions designed to guide students and families to and through the college application process. The goal of the College Edge Program is 100% college placement for low-moderate income Norwalk program participants. The program will run from September 14th - November 16th at the Learning Center on 20 West Ave.
Student Info
Student First Name *
Your answer
Student Last Name *
Your answer
Gender *
HS Class Year *
Preferred Student Telephone Number *
Your answer
Preferred Student Email Address *
Your answer
Permanent Home Address (Number & Street) *
Your answer
Permanent Home Address (City, State) *
Your answer
Permanent Home Address (Zip Code) *
Your answer
High School (e.g Norwalk High School) *
Your answer
Do you have any allergies? *
If yes, please identify:
Your answer
Do you take any medications regularly? *
If yes, please identify:
Your answer
Do you have any health concerns (e.g. asthma)?
If yes, please identify:
Your answer
Emergency Contact Info
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Family Info
Parent/Guardian 1 Name *
Your answer
Parent/Guardian 1 Phone Number *
Your answer
Parent/Guardian 1 Email Address *
Your answer
Parent/Guardian 2 Name
Your answer
Parent/Guardian 2 Phone Number
Your answer
Parent/Guardian 2 Email Address
Your answer
Annual Household Information
Eligible participants in the College Edge Program must reside in Norwalk households of low to moderate income.
Number of persons in household, including head of household: *
Please enter gross annual income for all persons living in the household who are over the age of 18 and not in school. *
Agreements
To ensure commitment to the program, new participants must submit a $50 deposit due September 14, which will be refunded after the participant completes the program in December. *
Media Release: I authorize HELP, Inc. to photograph me, take video footage of me, and/or make electronic sound recordings of me (herein referred to as photographic or electronic reproductions). I authorize the use of any such photographic or electronic reproductions of me for any purpose, including, but not limited to educational and other public media as may be deemed appropriate by HELP, Inc. (I understand that I may be identifiable from such photographic or electronic reproduction). *
Certification of Information: I hereby certify that the information on this form is complete and correct to the best of knowledge. I also hereby authorize the Redevelopment Agency of the City of Norwalk to verify any and all income information provided on this form. *
Do you have any comments, questions, concerns?
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