IGNITE 2017 Program Application

Please complete this application for Urban Restoration Enhancement Corporation's 2017 IGNITE Fellows program. IGNITE will operate at Southern University’s College of Business as follows: College Readiness Program, April 3–May 18, Monday – Thursday, 3:30pm to 5:30pm; ACT Boot Camp, May 30-June 8, 9:00am to 1:00pm; and Entrepreneurship Institute & Summer Job, June 19 – July 21, 7:30am to 3:00pm. For more info, call 225-356-8871 or email sgraves@urecbr.com.

Student's First Name
Your answer
Student's Last Name
Your answer
Gender
Required
Parent/Guardian's First Name
Your answer
Parent/Guardian's Last Name
Your answer
Address Line 1
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Email Address- Student
Your answer
Email Address - Parent/Guardian
Your answer
Phone - Home
Your answer
Phone - Cell
Your answer
Phone - Work
Your answer
Gross Monthly Income
Your answer
Total Number of Individuals in Household
Your answer
Family Type
Transportation is not provided for the program. Please indicate transportation arrangements for your child. Check all that apply.
Required
Please list any academic, college or career readiness skills you would like us to help your child strengthen.
Your answer
Your child's GPA
Your answer
Has your child taken the ACT?
If your child has taken the ACT, please list ACT score:
Your answer
Has your child expressed interest in a particular career or course of study after high school? If so, please indicate below.
Your answer
Use the space below to share any additional information.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms