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Rising Scholars New Student Interest Form 23/24
Please answer the following questions and a Rising Scholars team member will reach out to you.
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* Indicates required question
Last and First Name:
*
Your answer
Student ID Number:
*
Your answer
Email Address:
*
Your answer
Phone Number:
*
Your answer
How many units are you enrolled in?
*
0 points
Not registered in Mesa classes at the moment.
1-5
6-9
9 or more
Major/Area of Interest at Mesa:
*
Your answer
Have you ever been incarcerated?
*
0 points
Yes
No
Are you currently in a transitional reentry program? (CCTRP/MCRP)
*
Yes
No
Other:
If you are in a CCTRP program, please confirm you are phase 2 or 3.
*
Phase 2
Phase 3
Does Not Apply
Have you previously attended college?
*
Yes
No
If yes, were the classes taken while you were incarcerated?
*
Yes
No
Preferred way to contact you
*
Email
Phone
Other
How did you hear about Rising Scholars?
*
Your answer
Are you an EOPS student?
*
Yes
No
If yes, are you in CARE? (single parent receiving county CalWORKs)
Do you receive services from the following programs?
DSPS
STAR TRIO
Promise
FAST/Next Up
Pride Center
Borderless
N/A
Other:
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