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2022 Parent/Guardian Form


STUDENTS: DO NOT FILL OUT THIS FORM. 
PLEASE HAVE A PARENT/GUARDIAN COMPLETE IT.

CH Families, 

We are working to streamline the application process and make all parts of the application electronic to eliminate printing, scanning, and/or mailing hard copies. We will NOT ask families to mail copies of their tax forms. If your student is admitted to the program, parent/guardians may be asked to submit additional financial information to determine need-based financial aid and college financial fit.


APPLICATION DEADLINE (for New and Returning Applications):
March 1st, 2022 at 11:59pm MDT

Questions? Contact apply@collegehorizons.org.

Your Student


Primary Parent/Guardian Contact
We ask for families to identify one parent/legal guardian to serve as the primary contact for this summer’s program. Due to the remote structure of the program, we will need to be able to communicate application and program updates regularly with parent/guardian by email and phone. Please ensure this information is correct and complete.






Mailing Address Confirmation
We need your help verifying the mailing address for your student. All College Horizons participants will receive a college guide book, t-shirts and CH partner college information. We must have the correct mailing and physical address. Please complete this section carefully.
Below, please provide a MAILING address where you currently receive U.S. Postal Service mail. P.O. Boxes are acceptable in this section.






College Horizons also requires you to provide a physical SHIPPING address where you can receive UPS and FedEx packages. This is typically a street address - UPS and FedEx will NOT ship to a P.O. Box.







Parent/Guardian Reflection

COVID-19 Impact
The following questions are OPTIONAL. Please share only what you are comfortable disclosing. We are trying to get a full picture of your family's situation and this information allows us to identify resources and additional support that may be helpful.

Laptops/Devices

Income & Tax Information

Only enter numbers here, no commas or extra characters.

Only enter numbers here, no commas or extra characters.


Only enter numbers here, no commas or extra characters.






Family Structure for Financial Aid Counseling










Household Information




Please indicate the relationship and age for each family member in the parents' household below - to add a person, click the "Add a person" button in the lower right corner of this grid.

EXAMPLES:
Relationship: Mother; Age: 45
Relationship: Brother; Age: 10
Relationship: Age
Household Member
Household Member
Household Member
Household Member
Household Member


In your household, how many individuals who are listed on the tax return (including parents) are currently in college? Do not include household members who file as independent.


Federal Assistance & Dislocated Worker





Additional Information & Resources

PRIVACY STATEMENT & PARTICIPANT CONSENT

College Horizons, Inc. is committed to respecting the privacy rights of College Horizons, Scholars and Graduate Horizons participants, including students, faculty and volunteers. We are also committed to protecting the confidentiality of education records and to maintaining such records in accordance with applicable law.  The following statement describes the organization’s policy with respect to personal information collected from both applicants and participants in any College Horizons Inc. programs.

 

Application Information and Participant Information: Information supplied in a program application (“Applicant Information”) and information provided by a program participant (“Participant Information”) are secured and maintained solely by College Horizons, Inc. and will not be shared, sold, or made available to any unauthorized party except where required by law or court order. Applicant Information and Participant Information is used by authorized College Horizons, Inc. staff for internal and program purposes. College Horizons may use Applicant Information and Participant Information for research purposes and only with approval by the Board of Directors; in such instances, any personally identifiable information will be removed. College Horizons Inc. will publicly release and share basic demographic information of participants to complete fundraising reports, annual reports, and for the purpose of informing the public on meeting the mission of the organization. During the summer programs, faculty review Participant Information for instructional and curricular purposes. Faculty agree to keep all information confidential and private and are not permitted to disseminate or forward student information to any party, organization, or individual not affiliated with College Horizons, Inc. Volunteer counselors affiliated with College Horizons, Inc. agree that they will not use the student contact information to solicit or promote any products or services, including free or educational services, to the participants or their families.

 

Participant Contact Information: College Horizons, Inc. shares with partner colleges/universities the following Participant Contact Information: name, address, phone number, e-mail address, tribal affiliation, high school or college name, gender, and first generation to college status (“Participant Contact Information”). This information is included on a participant-and-faculty roster. College and university admissions representatives working in partnership with College Horizons, Inc. are provided a copy of this roster and encouraged to contact program participants as part of their college admission recruitment and outreach strategy. Participants are also provided with a copy of the roster and are encouraged to contact college and university representatives for more information on their institutions. College Horizons, Inc. also encourages participants to use the roster to stay in touch with other participants and for networking opportunities.

 

Follow Up Outreach: College Horizons, Inc. staff will periodically follow-up with participants and their parents/guardians by email, surveys, phone, and mailing to learn of the participant’s progress on college or graduate school applications, admissions, enrollment, and graduation, and to provide information on other educational opportunities supported by College Horizons Inc. and our partner colleges/universities. In addition, College Horizons, Inc. will send updates, surveys, newsletters, and annual reports to former participants as part of our communications and outreach plan. Following the program, parents/guardians and participants can opt out of College Horizons Inc. communications.

 

By signing below, I understand how Applicant Information and Participant Information will be used. I consent to the use of the information I have provided for research purposes.  I further consent to the publication and sharing of my, or my child’s, Participant Contact Information (as described above) in the participant-and-faculty roster, and I agree that the participant will be added to the College Horizons, Inc. mailing and emailing list to receive notifications about College Horizons information, and receive follow-up contact by College Horizons, Inc. as described in this Privacy Statement and Participant Consent to Use of Information. I understand that following the conclusion of the program, parents/guardians and participants can opt out of College Horizons Inc. communications.




YOU ARE NOT FINISHED! When you hit submit, you will be able to review your answers and you will be prompted for an "e-signature." Once you provide your e-signature, please check your email and click on the email confirmation link to verify (make sure to check your junk mail). 

YOUR FORM WILL NOT BE COMPLETE IF WE DO NOT RECEIVE YOUR E-SIGNATURE VERIFICATION.