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PREP FORWARD APPLICATION

"*" indicates required fields

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Student Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth *

Gender (please select one) *

Male
Female
Transgender
Non-binary/non-conforming

Ethnicity (check all that apply) *

White
Hispanic or Latino
Black or African American
Native American or American Indian
Asian / Pacific Islander
Other

Current Grade Level *

Current School *

Cumulative GPA *

Phone *

Email *

Social Media Handles *

Sports Played

Committees or Community Activities (e.g., church groups, mentorship programs, National Junior Honor Society, etc.)

Other Memberships, Achievements, etc

Parent/Guardian Name *

First

Last

Relationship to Student *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Phone *

Are you employed? *

Position/Title

Company

Highest Degree Received *

High school graduate, diploma or the equivalent (for example: GED)
Some college credit, no degree
Trade/technical/vocational training
Associate degree
Bachelor's degree
Master's degree
Professional degree

For the student, please outline your current and future goals. How will being a part of AD99 Solution’s cohort help you achieve those goals? *

For the student, AD99 Solution's core values are: Empowerment, Equity, Excellence, Integrity, and Stewardship. In no more than 500 words, please describe the value of each of these attributes and how you embody or plan to embody each. *

For the parent/guardian, how do you feel your student would benefit from AD99 Solution’s cohort? *

By submitting this application, you are verifying that all information provided is true and are willing to undergo a full background check. *

I agree

If you have any questions or need assistance with the application, please contact the Director of Prep Forward, Marritta Gillcrease at Marritta@AD99.org.

Please note, applications will be kept confidential and on file at the AD99 Solutions office. Applications are used to identify and evaluate cohort candidates.

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