Harlem Clemente Course Application
Please fill out the application if you are interested in completing the course. This is simply an informational sheet that allows us to get to know you a bit and understand your interest the Clemente Program.
Email *
Address *
Name *
Last Grade Completed *
Phone Number *
Are you currently enrolled in any educational programs? If so, which one? *
How did you hear about us? (Referred by friend or employee, Website, etc.) *
Tell us a little bit about yourself. *
Why are you applying to the Clemente Course? *
What do you like to read? Name a few of the most recent books you've read. *
What challenges you most about reading and wrtiting? *
What do you hope to learn or achieve in the Clemente Course? Write at least three statements that begin with the words, "In this course, I want to..." *
What will you need to do to accomplish the goals you've listed above? *
How can the instructors help you accomplish these goals? *
Do you really think you will be able to attend all classes twice per week for eight months? Do you foresee any challenges? Do you have any questions or concerns as this class begins that you'd like the instructor to address? *
Is there anything else you'd like to share with us? *
Please list contact information (phone numbers/email addresses) of three personal references. *
The Clemente Course is an unusual opportunity that we are offering to a few select individuals who are dedicated to attending regularly on Tuesdays and Thursdays in the evening for the entire 8-month course. By signing below you are agreeing to attend all class sessions and participate fully in the course. *
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