Name:

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* 1. Name:

Year of High School Graduation:

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* 2. Year of High School Graduation:

Philadelphia Futures Pre-College Program

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* 3. Philadelphia Futures Pre-College Program

College/ University You Currently Attend

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* 4. College/ University You Currently Attend

At what college/ university do you plan to take classes this summer?

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* 5. At what college/ university do you plan to take classes this summer?

Community College only: What is your J number?

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* 6. Community College only: What is your J number?

What courses do you plan to take? Please list the course name and course number for each course.

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* 7. What courses do you plan to take? Please list the course name and course number for each course.

What requirement(s) will this course/these courses fulfill? Please check all that apply.

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* 8. What requirement(s) will this course/these courses fulfill? Please check all that apply.

What are the start and end dates for the course?

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* 9. What are the start and end dates for the course?

Please estimate the cost of the course(s).

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* 10. Please estimate the cost of the course(s).

What is the payment due date for summer courses at this institution?

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* 11. What is the payment due date for summer courses at this institution?

Please explain your need to take summer courses. Please address (1) how you will benefit from taking courses this summer and (2) why you are a deserving recipient. Please be thoughtful and thorough in your responses.

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* 12. Please explain your need to take summer courses. Please address (1) how you will benefit from taking courses this summer and (2) why you are a deserving recipient. Please be thoughtful and thorough in your responses.

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