Pre-College Program Disclosure Request Form for Late Arrivals
The official start date of the Pre-College Program is June 14, 2024. If a program participant cannot arrive on the official start date, a Pre-College Program Disclosure Request Form must be submitted. 
Complete the request form below in its entirety. Forms not completed correctly will not be considered for approval. The deadline to submit this form is May 31, 2024 by 11:59pm.

Please Note: This form is not automatically approved upon submission. Each submitted form will be reviewed by the Pre-College Program Director. Upon review, the program participant and guardian will be notified of request approval/denial. 

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I (type your name below) will not hold the Pre-College Program/ Summer Bridge responsible for my academic outcome if I enroll in the program after Friday, June 14, 2024. I fully understand that this program covers material that is usually taught during an academic semester, which consists of sixteen weeks. Therefore, I know that any material missed is my responsibility. I am aware that I must speak with my instructors to find out any missed assignments and complete them in a timely fashion. I realize that my failure to follow through may result in a poor academic performance, and I am willing to take full responsibility for my actions.    *
Student's Name *
Student I.D. Number  *
Student's Email Address *
Student Signature
(*By typing my name I hereby sign this document)
 *
Date Arriving  *
MM
/
DD
/
YYYY
Parent/Guardian Name (Printed) *
Parent/Guardian Signature
(*By typing my name I hereby sign this document)
 *
Parent/Guardian's Phone Number *
Parent/Guardian's Email *
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