Road Map to College Interest Form
College is possible - we can help! If you are 18-24 and plan to attend (or are currently attending) Los Medanos College, and think you may benefit from additional assistance while you are in school, please fill out an application today. We accept 20 students per semester. Once you submit this form one of our College and Career Counselors will contact you to make an appointment. We look forward to working with you!
Email address *
Name *
First and last name
Your answer
Date of Birth *
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Phone number *
Your answer
What city do you live in? *
Your answer
Where do you plan to go to school this fall? *
Help us get to know you. What do you do for fun? What challenges are you facing, if any? What goals do you have for the future? Tell us as little or as much as you feel comfortable with. *
Your answer
Why do you want to join the Road Map to College program? *
Your answer
What is your ideal job after you finish school? *
Your answer
Will you have a high school diploma before July 2018? *
Is this your first time going to college? *
Please check all that apply below. Please be honest and know that we are here to help you. Answering these questions will help us understand what challenges you may be facing, if any. We focus on providing additional support to individuals facing any of the obstacles below. *
Required
How did you hear about us? *
A copy of your responses will be emailed to the address you provided.
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