Student Application 2021-2022 * Required Field Question Title * 1. Last Name: Question Title * 2. First Name: Question Title * 3. Preferred Name: Question Title * 4. Gender: Female Male Question Title * 5. Ethnicity African American White Hispanic American Indian Asian Pacific Islander Multiple Races Question Title * 6. Date of Birth: Please Enter: Date Question Title * 7. Place of Birth (City, State): Question Title * 8. Please share who referred you to REACH Memphis. REACH Memphis student participant REACH Memphis parent REACH Memphis mentor REACH Memphis staff member Other (please specify) Question Title * 9. Please provide the name, email address, and/or phone number of the person who referred you. Question Title * 10. School Name: Question Title * 11. Grade: Question Title * 12. School Guidance Counselor's Name Question Title * 13. Student Address: Question Title * 14. City: Question Title * 15. State: Question Title * 16. Zip Code: Question Title * 17. Home Phone: Question Title * 18. Your Cell Phone: Question Title * 19. Your Email Address: Question Title * 20. What student leadership positions have you held? Question Title * 21. What special recognitions have you received? Question Title * 22. Have you had a previous summer experience at a prep school, college, or leadership program? Yes No Question Title * 23. If the answer to #22 is Yes, where have you gone? Question Title * 24. Have you participated in a virtual summer experience? Yes No Question Title * 25. If the answer to #24 is Yes, what type of virtual program did you participate in and what school offered the visual program? Question Title * 26. What are your career aspirations? Career Aspiration 1 Career Aspiration 2 Question Title * 27. What extracurricular activities do you participate in? Question Title * 28. What are your special talents or skills? (e.g., singing, playing an instrument, acting, drawing) Question Title * 29. What are your hobbies? Question Title * 30. Please indicate the sports in which you participate (check all that apply). Baseball Football Basketball Softball Soccer Rugby Tennis Volleyball Track and Field LaCrosse Swimming Cheerleading Other (please specify) Question Title * 31. Is there a day of the week that you CANNOT participate in a REACH Memphis session? (Please list the day.) Question Title * 32. If accepted, will you agree to participate in bi-monthly sessions? Yes No Question Title * 33. Is there a primary language, other than English, spoken in your home? Yes No Question Title * 34. If the answer to #33 is Yes, what language is spoken? Question Title * 35. What foreign languages, if any, are you studying at school? Question Title * 36. Will you be the first person in your family to attend college? Yes No Question Title * 37. If the answer to #36 is No, who in your family attended college? (Click all that apply) Sibling Parent Grandparent Other (please specify) Question Title * 38. Who in your family has graduated from college? (Click all that apply) Sibling Parent Grandparent No One Other (please specify) Question Title * 39. Is anyone in your family a REACH Memphis (formerly Memphis PREP) alumnus? If so, please provide maiden name and current name. Question Title * 40. What organizations do you belong to outside of school? Question Title * 41. With whom do you live? Mother Father Mother and Father Grandparent(s) Other (please specify) Question Title * 42. Name of Parent or Guardian 1: Question Title * 43. Relationship to Applicant: Question Title * 44. Occupation: Question Title * 45. Employer: Question Title * 46. Work Phone: Question Title * 47. Home Phone: Question Title * 48. Cell Phone: Question Title * 49. Email Address: Question Title * 50. Name of Parent or Guardian 2: Question Title * 51. Relationship to Applicant: Question Title * 52. Occupation: Question Title * 53. Employer: Question Title * 54. Work Phone: Question Title * 55. Home Phone: Question Title * 56. Cell Phone: Question Title * 57. Email Address: Question Title * 58. Emergency Contact Name: Question Title * 59. Emergency Contact Phone: Question Title * 60. How many people are in your household? Question Title * 61. Please indicate your t-shirt size. Small Medium Large Extra-Large 2XX 3XXX Question Title * 62. ESSAYCut and paste a 350-500 word essay into this essay template using the following prompt:Describe a challenge you have faced and how it impacted you. What did you learn? How do you view yourself because of it? Done