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PUENTE HIGH SCHOOL PROGRAM (Parent/Guardian) APPLICATION FORM
To be completed by student’s Parent/Guardian. *Your student-applicant should not be involved in another program such as AVID, STEM, etc.
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* Indicates required question
Student’s Name (Last name first)
*
Your answer
Street Address, City, Zip Code:
*
Your answer
Home phone # or cell phone #
*
Your answer
With whom do you live?
*
Mother
Guardian
Stepmother
Other
Last Name, First Name of parent/guardian above.
*
Your answer
Occupation:
*
Your answer
Work phone
*
Your answer
E-mail
*
Your answer
Choose one: With whom do you live? Father/Guardian/Stepfather/Other?
*
Your answer
Last Name, First Name of parent/guardian above
Your answer
Occupation
*
Your answer
Work phone #
*
Your answer
E-mail:
*
Your answer
Cell phone #
*
Your answer
Mother's Highest Level of Education
*
Did not graduate High School
High School Graduate
Some college, no BA degree
Bachelors of Arts /Bachelors of Science degree or higher
Not applicable/don’t know
Required
Father's Highest Level of Education
*
Did not graduate High School
High School Graduate
Some college, no BA degree
BA/BS degree or higher
Not applicable/don’t know
Required
Sibling's Highest Level of Education
*
Did not graduate High School
High School Graduate
Some college, no BA degree
BA/BS degree or higher
Not applicable/don’t know
Required
The primary language spoken at home is:
*
English Only
Spanish Only
English and Spanish
Other: please submit language in next question.
Required
If you answered "other" in the last question, indicate what language you speak.
Your answer
How many people live in your household?
*
Your answer
How many sons do you have?
*
Your answer
How many daughters do you have?
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Your answer
How many others live in your household?
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Your answer
Have you or anyone in your immediate family ever attended a college/university?
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Yes
No
If you answered "yes" to the above question, who is this family member and what university did this family member graduate from? If none, write "no one".
*
Your answer
Why do you want your son/daughter to participate in Puente? *Feel free to answer in Spanish or English.
*
Your answer
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