TCC Men of Distinction Summer Academy 2013
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1
. Please complete your contact information.
Please complete your contact information.
Name:
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Email Address:
Phone Number:
*
2
. What is your race? Please choose one or more.
What is your race? Please choose one or more.
White
Black or African-American
Spanish/ Hispanic/ Latino/a
Asian
Native Hawaiian or other Pacific Islander
American Indian or Alaska Native
Other
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3
. High school attended?
High school attended?
4
. Will you graduate, or complete your GED by June 25, 2013?
Will you graduate, or complete your GED by June 25, 2013?
Yes
No
5
. Why are you interested in joining the Men of Distinction Summer Academy?
Why are you interested in joining the Men of Distinction Summer Academy?
6
. Are you planning to continue your education at Tacoma Community College once the Summer Academy ends?
Are you planning to continue your education at Tacoma Community College once the Summer Academy ends?
Yes
No
7
. What is your long term career goal?
What is your long term career goal?
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8
. Have you completed a Tacoma Community College Admissions applicaiton?
Have you completed a Tacoma Community College Admissions applicaiton?
Yes
No
9
. Have you completed the FAFSA (Free Application for Federal Student Aid) for the following years? If you answered no to either one of these years, you will need to go to: http://www.fafsa.ed.gov/ to complete these applications as soon as possible.
Have you completed the FAFSA (Free Application for Federal Student Aid) for the following years? If you answered no to either one of these years, you will need to go to: http://www.fafsa.ed.gov/ to complete these applications as soon as possible.
2012/13 - school year that ends August 30, 2013 (needed for summer financial aid.)
2013/14 - school year that ends August 30, 2014
10
. How did you hear about this program?
How did you hear about this program?
High school counselor
Career counselor
Tacoma Community College Outreach and Recruitment staff
Friend or Family member
Other community resource
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