2022 Fall College Edge Program Application
The College Edge Program is a comprehensive series of college-readiness workshops, SAT test preparation lessons,  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. Session will take place at YBI located on 11 Day St on Wednesdays from 6:30pm - 8pm
Sign in to Google to save your progress. Learn more
Student Info
Student First Name *
Student Last Name *
Gender *
Preferred Student Telephone Number *
Preferred Student Email Address *
Permanent Home Address (Number & Street) *
Permanent Home Address (City,  State) *
Permanent Home Address (Zip Code) *
High School (e.g Norwalk High School) *
Do you have any allergies? *
If yes, please identify:
Do you take any medications regularly? *
If yes, please identify:
Do you have any health concerns (e.g. asthma)?
Clear selection
If yes, please identify:
Emergency Contact Info
Emergency Contact Name *
Emergency Contact Phone Number *
Family Info
Parent/Guardian 1 Name *
Parent/Guardian 1 Phone Number *
Parent/Guardian 1 Email Address *
Parent/Guardian 2 Name
Parent/Guardian 2 Phone Number
Parent/Guardian 2 Email Address
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: *
Ethnicity of Head of Household *
Race of 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. *
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?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy