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CG Student Services Application
A.
Please read each section carefully and full out completely.
B.
Students cannot participate in program activities until all application materials are turned in.
C.
If you have questions please contact our office at (773) 660-1677.
* Indicates required question
Student's First & Last Name
*
Your answer
Address (please include City & Zip Code)
*
Your answer
Email
*
Your answer
Phone number
Your answer
Age
Your answer
Date of Birth
MM
/
DD
/
YYYY
Parent/Guardian Contact Name
Your answer
Parent/Guardian Contact Phone
Your answer
Ethnic/Racial Background
African American
Latina American
Caucasian American
Asian American
Native American
Other:
U.S. Citizen (Your answer is confidential and will not affect your enrollment in the program)
Yes
No
Clear selection
Name of Church (if applicable, church membership is not required.)
Your answer
Name of High School
Your answer
Grade Level
Your answer
G.P.A.
Your answer
Year of Graduation From High School?
Your answer
Are you or your family receiving family assistance (public aid assistance, etc.)?
Yes
No
Are you pregnant or parenting?
Yes
No
Maybe (pregnant)
If yes, how many children?
Your answer
Please check t-shirt size:
XS
S
M
L
XL
XXL
XXXL
List any church/community/school clubs or organizations that you are a member of:
Your answer
Has anyone in your immediate family (mother, father, sister, brother) graduated from a four year college/university (received a B.A.)?
Yes
No
I am interested in: (Only Check One)
Attending College
Trade School
Entrepreneurship
Entry Level Job Placement
I understand that The Christian Guild will use the data provided on this form to assist in my enrollment and will be used in confidence. I certify that all information provided is true and correct to the best of my knowledge.
Yes
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