CampusGroups

First Name *

Middle Name

Last Name *

Preferred Name

High School *

UPIKE email

Personal email *

Cell phone number *

T-shirt size *

Emergency Contact Name(s) and Relationship to You *

Emergency Contact Number(s) *

Intended major *

Intended Career Pathway *

Are there any other majors or careers that you would like to have more information on?

Have you completed your 2024-2025 FAFSA? *

If you were selected for verification by KHEAA or were notified of any other issues related to your financial aid package, have you completed/resolved them? *

Are you currently registered for a GROWL session? *

Have you taken dual credit courses during high school that you will receive college credit? If yes, list courses and college(s) courses were completed through. *

Do you own a personal laptop/device? *

On a scale from 1-10, please indicate your level of challenge with Time Management.

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On a scale from 1-10, please indicate your level of challenge with Study Skills.

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On a scale from 1-10, please indicate your level of challenge with Stress Management.

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On a scale from 1-10, please indicate your level of challenge with Decision on a Major.

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On a scale from 1-10, please indicate your level of challenge with Confidence in Your Major.

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On a scale from 1-10, please indicate your level of challenge with Confidence in Your Career Choice.

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On a scale from 1-10, please indicate your level of challenge with Advocating for Yourself.

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On a scale from 1-10, please indicate your level of challenge with Using Technology.

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On a scale from 1-10, please indicate your level of challenge with Confidence in Writing.

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On a scale from 1-10, please indicate your level of challenge with Confidence in Math.

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On a scale from 1-10, please indicate your level of challenge with Financial Planning and Budgeting.

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Why are you interested in the UPIKE FIRST Summer Bridge program? *

What are you hoping to gain from the experience? *

Do you have access to reliable transportation to and from campus multiple days/week? *

Yes

No

Comments:

Do you foresee any circumstance that will interfere with you attending course meetings? *

Yes

No

Comments:

By providing my e-signature, I understand attendance is required and I will earn a grade for a two credit hour course for the successful completion of FS 102. *

UPIKE FIRST Summer Bridge Program Application 2024