Transition Coach Application - New York Spring 2016

1. Contact

Volunteer Transition Coaches provide over-the-phone, e-mail, texting, and in-person support to low-income and first-generation college-bound high school seniors.

Volunteer Transition Coaches commit at least 3 evening hours per week from January to May to providing phone, e-mail, and in-person office hours. In-person office hours are provided at the Let's Get Ready office, 50 Broadway, 25th Floor, New York, NY 10004.

Training is provided by the Let's Get Ready office.

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* 1. Today's Date:

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* 2. First Name:

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* 3. Middle Initial:

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* 4. Last Name:

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* 5. Gender:

Male

Female

Other

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* 6. Birth Date (mm/dd/yyyy):

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* 7. College/University:

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* 8. Major/Minor:

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* 9. Expected Graduation Date:

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* 10. Cumulative College GPA:

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* 11. Current/Campus Address

Address: *

City/Town: *

State: *

Country:

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* 12. Cell Phone:

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* 13. Permanent Address-if different from current address

Address:

City/Town:

State:

ZIP/Postal Code:

Country:

Phone Number:

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* 14. School Email Address (if you have one):

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* 15. Personal Email Address (if you have one):

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* 16. High School Attended:

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* 17. Emergency Contact Information:

Contact Name

Relationship to you

Phone Number

Email Address