* 1. First & Last Name:

* 2. Date of Birth:

* 3. Are you under 18 years of age?

* 4. * If you are under 18 Years of Age, please include your parents contact information (Name, Email, & Phone Number)

* 5. High School Name:

* 6. Grade

* 7. Phone Number

* 8. Email:

* 9. Home Address:

* 10. Are you a West Los Angeles College Promise Student?

* 11. Have you completed the Online Application?

* 12. West Los Angeles College ID number: (#88)

* 13. Have you taken the English Assessment?

* 14. If you have taken the English Assessment, what level did you test into?

* 15. Have you taken the Math Assessment?

* 16. If you have taken the Math Assessment, what level did you test into?

* 17. Please briefly explain your reasons for wanting to participate in the Summer Bridge Program.

* 18. Please list a few activities you would like to see happen during Summer Bridge.

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