On Track To College Success Application

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On Track To College Success Application - Summer 2024

Please complete the following form to apply for North Central's On Track Summer Program.

This program is a 5-week in-person summer program designed to give first-year college students a jump on a successful first year in college. There is no fee to apply. Participants who complete the program will be eligible to receive up to $175 in gas cards, school supplies, and special prizes. Participants who attend North Central in the fall of 2024 will receive all of the prior listed items plus a new laptop valued at approximately $1,000.

8:30 am - 1:00 pm

Monday - Thursday

July 15th - August 15th

at the Gaylord North Central Center

Email *

First Name
*

Last Name
*

Preferred name if different from your legal name.

Cell Phone Number
*

Date of Birth
*

YYYY

Gender
*

Male

Female

Non-Binary

Prefer not to say

What is your Race/Ethnicity?
*

Black or African Amerian

White

Asian

Native American/Indegenous Person

Hispanic/Latinx

Native Hawaiian or Other Pacific Islander

Two or more races

Unknown or Prefer not to report

Home Address. Please include your physical address which includes street, city, state, and zip code.
*

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