Online Registration Form (Registration closes Friday, May 19th)

Thank you for your interest in EAOP's College Prep Academy!
Upon completion of both the Online Registration Form and Waiver Forms, you will be given a confirmation email with further details closer to the day of the event. If you have any questions, please contact Norman Borgonia via email (norman.borgonia@ucr.edu) or phone (951.827.7286).

Please note the following MANDATORY dates and times:

Math/Writing Pre-Assessment
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Saturday, June 3rd from 9:00am - 12:00pm at the UC Riverside Campus
Parent Meeting - Tuesday, June 27th from 6:30pm - 7:30pm at the UC Riverside Campus
Program Dates - Monday through Thursday from July 10th to July 20th from 8:00am - 3:00pm at the UC Riverside Campus

* 1. Student's First Name:

* 2. Student's Last Name:

* 3. Student's Gender

* 5. Student's High School Graduation Year:

* 7. Do you belong to any of the following Community Based Organizations?

* 8. Student's Primary Email Address:

* 9. Student's Primary Phone Number:

* 10. Parent's Primary Email Address:

* 11. Parent's Primary Phone Number:

* 12. Primary Language Spoken in Household:

* 13. Does the student need special accommodations due to a disability?

* 14. If yes, please specify need:

* 15. Do you have any dietary restrictions?

* 16. What math class do you anticipate enrolling in for Fall 2017 (next school year)?

* 17. MANDATORY MATH/WRITING PRE-ASSESSMENT
(Saturday, June 3rd from 9:00am - 12:00pm)

This Pre-Assessment is necessary for placing the student in the appropriate course for the program. Those that cannot attend must contact Norman Borgonia (951.827.7286) to set up an alternative. Students that fail to take the Pre-Assessment will be placed on the Wait List.

* 18. MANDATORY PARENT MEETING
(Tuesday, June 27th from 6:30pm - 7:30pm)
This Parent Meeting is necessary for going over the details of the program, expectations both parents and students, and logistics of the event. Parents will receive their students Pre-Assessment scores that day as well. If a Parent cannot attend, the Student can come in their place. If neither the Parent or Student attends, they will be placed on the Wait List.

* 19. MANDATORY WAIVERS:
After clicking the Submit button below you will be redirected to another webpage where you can download the required forms to participate in College Prep Academy. These forms MUST be returned to our office no later than Friday, May 19th. Instructions on completing and returning the forms can be found in the packet. If you have any questions, please contac Norman Borgonia via emal (norman.borgonia@ucr.edu) or phone (951.827.7286). Your registration is not complete until we receive all completed forms.

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