Prospective Scholar Intake Form

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Personal Information

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Mobile Phone

*( )

Home Phone

( )

Date of Birth (mm/dd/yyyy)

Email Address *

Name of High School *

Enter the name of the high school here

Graduation Month *

Graduation Year *

Will you be the first person in your family to attend a 4-year College or University? * YesNoNot Sure

What program referred you to SCS? *

Academic Information

Current GPA *

Class Rank

Class Size

SAT Results (if applicable)

Total SAT Score

Math

Writing

Critical Reading

ACT Results (if applicable)

ACT Composite Score

English

Reading

Science

Writing

Math

AP Courses

Course

Score

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Financial Awards

Institution

Amount

Type

Renewable YesNo

Add another award

Honors & Awards

Please list any Honors or Awards that you have received. *

Colleges & Universities

Please list the colleges & universities that you are interested in applying to (list only top 10 choices). * Use "UC" for University of California and "CSU" for California State University

Submission

By submitting this application, you hereby authorize South Central Scholars (SCS) to share any information provided to SCS or any SCS employee, whether provided in this application or otherwise, and whether previously provided or provided in the future, with other SCS employees or with third parties as SCS deems helpful or necessary to achieve the goals of SCS. *

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