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Educational Opportunity Program
2022 Commuter Summer Bridge Application
Program Dates: Sunday, June 19 – Thursday, July 13, 2022
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* Indicates required question
Email
*
Your email
1. CSUSB Email
*
Your answer
2. CSUSB Coyote ID#
*
Your answer
3. Last Name
*
Your answer
4. First Name
*
Your answer
5. Mailing Address (e.g. 5500 University Pkwy)
*
Your answer
5. City (e.g. San Bernardino)
*
Your answer
6. Zip (e.g. 92407)
Your answer
8. Birth Date
*
MM
/
DD
/
YYYY
9. Home Phone Number
*
Your answer
10. Cell Phone Number
Your answer
11. Gender
*
Male
Female
Transgender
Gender-queer/Non-conforming
Prefer not to answer
Other:
12. What is your preferred T-shirt size? (If you are unsure of your size, it is recommended you select one size larger to make sure that shirt fits comfortably)
*
S
M
L
XL
XXL
XXXL
13. Are you a current or former foster youth student?
*
Yes
No
14. High School
*
Your answer
15. County of High School
*
Your answer
High School Graduation Date
*
MM
/
DD
/
YYYY
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