* 1. Name:

* 2. Year of High School Graduation:

* 3. Philadelphia Futures Pre-College Program

* 4. College/ University You Currently Attend

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

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

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

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

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

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

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

* 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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