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Student Participant Contact Information

Full Name (first, middle, last) *Enter your name

Preferred name *optional* (if different from above)

Gender *

MaleFemaleOther

Other *

What pronouns to you use?

he/himshe/herthey/themOther

Other *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Email Address *

Date of birth *

Do you have a documented intellectual disability? *

Primary Citizenship *

Do you have dual citizenship? *YesNo

Dual Citizenship *

Are you Hispanic or Latino?YesNo

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other PacificWhite

Parent/Family Member/Guardian Contact Information

(Please list any parent, family member, or other contact person who will be helping with this application process, and whom you give permission for us to contact as needed.)

Contact 1

Name *

Relationship to Applicant: *

Phone Number *

Email Address *

Contact 2

Name

Relationship to Applicant:

Phone Number

Email Address

Tell Us About Yourself

If you are currently a high school student, what is the name of your high school? *

When do you expect to finish high school? *

When do you plan to start college? *

Did you exit high school (or do you plan to do so) with: *Standard High School DiplomaAlternative High School Diploma No diploma

What activities (sports, clubs, teams, social activities) have you participated in during high school? (These could be school-based or in the community.) *

What are some reasons why you want to attend college? *

What are some subjects that interest you? *

Is there anything else you would like to tell us about yourself? *

Other (Explain): *

How did you hear about UK-SHEP? *