21^st Century Southeast Scholars Program

Fields marked with an * are required.

Student Application Form

* Full Name:

* Student ID#:

* Major:

* Academic Status:

* Fall 2007 Enrollment Status:

* Mailing Address:

* City:

* State:

* Zip:

* Email Address:

* Home Phone:

* Cell Phone:

* Career Goal:

* Gender:

* Age:

By submitting this form, I agree to the following:

I will actively participate in the events and programs sponsored by the 21^st Century Southeast Scholars Program.
I will keep regular contact or schedule appointments with my peer mentor during the academic year (minimum one every two weeks).
I will contact a 21^st Century Southeast Scholars program coordinator if I begin to have problems related to school (i.e. academic, personal, or career).
I will maintain at least a 2.0 G.P.A. each semester.

21st Century Southeast Scholars Program