Rising Scholars New Student Interest Form 23/24

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Please answer the following questions and a Rising Scholars team member will reach out to you.

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Last and First Name: *

Student ID Number: *

Email Address: *

Phone Number: *

How many units are you enrolled in? *

0 Punkte

Not registered in Mesa classes at the moment.

1-5

6-9

9 or more

Major/Area of Interest at Mesa: *

Have you ever been incarcerated? *

0 Punkte

Yes

Are you currently in a transitional reentry program? (CCTRP/MCRP)
*

Yes

Sonstiges:

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

If yes, were the classes taken while you were incarcerated? *

Yes

Preferred way to contact you *

Phone

Other

How did you hear about Rising Scholars? *

Are you an EOPS student? *

Yes

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

Sonstiges:

Senden

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