Cultivate ACCESS Scholar Application

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Applicant Information

Applicant Name *

Applicant Age *

Applicant's current year in school *

Freshman

Sophomore

Junior

Senior

Applicant Gender

Applicant High School *

Applicant Email *

Applicant Mailing address *

What is your ethnic-racial background? Check all that apply

Black or African American

East Asian or Asian American

Hispanic or Latino/a

Native American or Alaska Native

White, Non-latino/a

Middle-eastern or Arab American

Pacific Islander

South Asian

Prefer not to answer

Other:

Parent/Guardian Information

Please provide contact information for your parent or guardian.

Parent/Guardian Name *

Parent/Guardian Email *

Parent/Guardian Phone Number *

Parent/Guardian Mailing address *

Reference information

Please provide name and contact information of a High School Teacher who can serve as a reference for your application

Reference Name *

Reference Email *

Reference Phone Number *

Reference Mailing Address *

Short Essay Questions

Please respond to the following questions in 250 words or less.

If you had the opportunity to solve a challenge facing society, which challenge would you solve and why? *

As part of the program, you will be assigned a mentor. To help match you with a potential mentor, please provide a short description of yourself. In your response, you may discuss your background, your identity, your family, your interests, career goals etc. *

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