Connecting to College Request
No identifying information from students/families will be shared with Michigan College Access Network; Student information collected here is used internally for evaluation follow up and tracking data locally.  All reporting information will be aggregated to preserve student anonymity.
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Person completing the form: *
Agency/School/Organization through Whom Request is Being Submitted (If your organization is not represented below, or if you are an individual, please contact Mason County Family Link for assistance) *
Email address of above individual/group submitting request *
First Name of Student *
Last Name of Student *
If there are any additional students in grades 9-12 or at WSCC in the household, please note the student's first name (and last name if different) and grade level here.
Parent or Guardian First Name (if applicable)
Parent or Guardian Last Name (if applicable)
Parent or guardian email or phone if applicable (for follow-up evaluation)
Student/Parent Street Address *
City/Town
Student/Parent State *
Student/Parent  Zip Code *
Student Email (for purposes of monthly evaluation) *
School *
Grade of Student in the 2020-2021 Year *
What are the funds being requested for *
What is the amount of the request? *
How has COVID-19 impacted this student/family (Check any that apply)? *
Required
What pre-college or college related activities will this student be able to participate in with the assistance from this program? *
Required
An short evaluation is required to track how many hours a student spends on online college-readiness or college going activities during each month for which they received assistance.  Is the student willing to complete the evaluation on their own or work with MCFL staff to complete the evaluation? *
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