Upward Bound:



South Mountain Community College

Upward Bound

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WHAT IS UPWARD BOUND?

Upward Bound is a FREE program funded by the U.S. Department of Education that offers academic, personal and social support to high school students through their entrance into postsecondary education. Upward Bound is a motivational and academically based program assisting students with high school graduation, and preparing students for enrollment and completion of postsecondary education.

BENEFITS OF UPWARD BOUND?

With this program, students will receive amazing support and opportunities that will greatly increase their success in high school, as well as in post-secondary education. Upward Bound participants are able to:

▪ Improve academic skills by attending classes in math, science, English, foreign language, and study skills every other Saturday during the school year (Saturday Academies) and the 6-week summer program at South Mountain Community College

▪ Participate in one-on-one mentoring with an academic/career advisor

▪ Attend career exploration and personal enrichment workshops

▪ Benefit from counseling services

▪ Participate in fun cultural, social, career, and college oriented field trips

▪ Receive weekly after-school tutoring and lunch time mentoring sessions

▪ Receive stipends (get paid!!) during the academic year (up to $40 per month)

▪ Participate in our Summer Residential Program at Northern Arizona University

▪ Receive high school graduation advisement

▪ Assistance with college entrance requirements

▪ Become informed of financial aid and scholarship opportunities

▪ Meet new friends & have fun!

WHO CAN PARTICIPATE?

▪ Students attending Central High School or South Mountain High School

▪ Demonstrate a need for academic support in high school and has the potential for academic success in postsecondary education

▪ Must be a first-generation college student (parent/guardian has not attained a four-year college degree), and/or

▪ Meet low income requirements (defined by the federal government standards)

▪ Be between the ages of 13-19

▪ Be a citizen or permanent resident of the United States

South Mountain Community College ◊ TRIO Programs ◊ 7050 South 24th Street, Phoenix AZ 85042 ◊ (602) 305-5676

South Mountain Community College

Upward Bound

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APPLICATION CHECKLIST

( Read the What is Upward Bound? page completely to assure you

qualify for the program. Share this information with your

Parent/Guardian (page 1)

( Complete the Student Application form and sign (yellow pages 3-4)

( Complete the Student Personal Statement (yellow pages 5-6 or attach a copy)

( Attach a copy of your current class schedule

( Have your parent/guardian complete and sign the Parent/Guardian

Information Sheet and Permission Form (green pages 7-10)

( Attach a copy of your parents’/guardians’ most recent federal income tax

papers. This document must be signed by your parent/guardian!

( If your parent/guardian did not file an income tax statement in 2017

please have them complete part B of the Income Information section

on the parent/guardian information section (green page 9)

( Have your counselor read the Counselor/Teacher Letter and complete and sign the referral form (blue pages 11-12)

o Make sure to check out and like our Facebook page.

o Search for us under: Upward Bound at SMCC

CENTRAL HIGH SCHOOL: Please turn in your completed application (all sections) to Central Counseling Office, along with a signed copy of your Parent/Guardian’s most recent Federal Income Taxes.

SOUTH MOUNTAIN HIGH SCHOOL: Please turn in your completed application (all sections) to SMHS Counseling Office, along with a signed copy of Parent/Guardian’s most recent Federal Income Taxes.

Please feel free to contact us if you have any questions regarding the program:

Upward Bound @ South Mountain Community College

7050 South 24th Street

Phoenix, AZ 85042

(602) 305-5676

South Mountain Community College

Upward Bound

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STUDENT APPLICATION

Last Name: First: MI

SS#_________-________-___________ SID #_________________ Birth Date:

Mailing Address:

City: , AZ Zip Code: PH# ( ) ___ ___-_________

Email Address: _______________________________________ Cell# ( ) ______-_________

Gender: Female: ______ Male: ______ Current age at enrollment date: __________________

Ethnicity: American Indian/Alaskan Native: ____ African-American/Black: ____ Hispanic/Latino: ____

Asian: ____ Caucasian/White: _____ Pacific Islander/Native Hawaiian: ____

Other: (specify) _____________

U.S. Citizen: Yes: No: If no, are you a Permanent Resident? A#_______________

(If you have been living in the United States with the intention of becoming a permanent resident, please

attach documentation from the U.S. Immigration and Naturalization Services to this application.)

Eligibility: Does either parent have a Bachelor’s degree? Yes: ______ No: ______

With whom do you live with? Both Biological Parents: _______ 1 Biological Parent: _______

Foster Parent: _______ Step Parent: _______ Other:(specify) ___________________________________

Is English spoken as the primary language in your home? Yes: _____ No: _____

If no, please specify the primary language: _________________________________

High School Information: What is your High School GPA? __________

_____Freshman (9th) Which high school do you attend?

_____Sophomore (10th) Central High______ (040633000542)

_____Junior (11th) South Mountain High ______ (040633000552)

_____Senior (12th)

Who is your High School Counselor? __________________What lunch period do you have? 1st___ 2nd___

Please provide the name of the Middle School/Junior High you attended:

______________________________________________________________________________________

(School name) (city, state) (grades attended)

Do you have a disability requiring accommodations? Yes: _____ No: _______

If Yes, please explain: ________________________________________________________________

Please list any extracurricular activities you are involved with: (sports, clubs, church, work, volunteer, etc.)

1.________________________ 2. ______________________ 3. ______________________

4.________________________ 5. ______________________ 6. ______________________

What is your educational goal? A.A. Degree: ___ B.A. Degree: ___ M.A. Degree: ___ Ph.D. Degree: ___

Professional Degree: ____ Other: ______________________________

Have you ever participated in any TRIO programs or other college preparatory programs such as:

Educational Talent Search: ______ Upward Bound: _____ ACE: ______ HOOP: ______

EOC: ______ Other: (please provide program name) _______________________________

Personal Assessment: Please list the career fields/majors or occupations you are most interested in.

1._______________________ 2. ________________________ 3. __________________________

Please list the colleges or universities you are interested in attending.

1._______________________ 2. ________________________ 3. __________________________

Please list all the academic areas you would like assistance with (you may check more than one).

English Composition/Literature_____ Mathematics_____ Science_____ Foreign Language_____

English as a Second Language_____ Other Subjects________________________________________

Academic Support Needed: Please check those areas you feel in need of information and assistance:

___Academic Advising ___Counseling ___College Admissions ___Math Enrichment

___Note Taking ___Tutoring ___Financial Aid Assistance ___University Tours

___ACT/SAT Preparation ___Study Skills ___College Exploration ___Career Advising

STUDENT RESPONSIBILITY

My signature below indicates my understanding and agreement to the following:

• All of the above information is true and correct to the best of my knowledge.

• I agree to actively participate in SMCC’s Upward Bound program which includes: participating in tutoring sessions, weekly lunch meetings, enrichment sessions, field trips/tours, Saturday Academies, and attend the 6-week summer and residential program.

• I understand that difficulty in making academic progress and not meeting the program requirements may result in possible probation/dismissal from the Upward Bound Program.

• I give permission to have my name and/or picture published in any program marketing materials without any compensation of any kind or restriction of its use.

• I authorize Upward Bound to have access to my school (academic/financial) records while in the program with respect to confidentially for program purposes only.

• I understand that the program data collected is used for tracking and research purposes.

•

Student Signature: ____________________________________________ Date: ____________________

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| |STUDENT PERSONAL STATEMENT |

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| |Upward Bound would like to know more about you. This statement must be NEATLY HANDWRITTEN OR TYPED. (You may attach an additional |

| |sheet of paper if needed). |

| |Please tell us in 200 words: |

| |What makes you unique and special? |

| |Why you would benefit from SMCC’s Upward Bound Program? |

| |What are your personal and educational career goals? |

| |Describe the type of commitment necessary to be a success in Upward Bound. |

| |Why should Upward Bound select you as a participant? |

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Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

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Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

South Mountain Community College

Upward Bound

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Parent/Guardian Information

Dear Parent/Guardian:

If you dream of a college education for your high school student, we’d like to help. The Upward Bound Program at South Mountain Community College is a FREE program funded by the United States Department of Education. Our purpose is to assist and motivate students to succeed and graduate from high school, and enroll and complete a postsecondary education of their choice. Our Upward Bound Program will serve a total of 50 students from Central & South Mountain High Schools in a variety of ways. We will be helping your child improve their academic skills through tutoring after school at least once a week. We will also be helping your child to improve personal skills through enrichment sessions such as study skills, time management, career exploration, critical thinking, and individual college success plans.

The Upward Bound program is federally funded and it is required that a majority of the participants meet guidelines set forth by the Department of Education. Participants must be either low income or potential first-generation college students. For this reason, we are asking you to provide information on the following “Parent/Guardian Information Form” regarding educational level and household income. We are also asking you to attach a signed copy of your most current federal income tax returns. This information will be kept confidential and will only be used for student selection and statistical documentation.

South Mountain’s Upward Bound program is working cooperatively with your child’s high school and with your child’s counselor. In order to better assist students it is important that our program staff have access to school records to determine your child’s academic needs and to develop plans to meet those needs. Your signature on the “Parent/Guardian Permission Form” portion of the form will allow our staff access to school records. Once again, this information will remain strictly confidential.

Your child is asked to complete the “Student Application and Personal Statement” section of this application. We are asking you to complete and sign the “Parent/Guardian Information” section and we are asking for your son’s/daughter’s counselor/teacher to fill out the “Counselor/Teacher Referral Form.” Completed applications are due to our TRIO office or to your child’s counseling office!

If you have any questions regarding this program or the requested information, please feel free to contact us at (602) 305-5676.

Sincerely,

Laura Smith

Upward Bound Coordinator

South Mountain Community College

Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

South Mountain Community College

Upward Bound

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Información para Padres/Guardián

Estimados Padres/Guardianes:

Si usted sueña para una educación para su estudiante de preparatoria, nos encantaría ayudarle. El programa Upward Bound es un programa GRATIS patricionado por el Departamento de Educación de los Estados Unidos. Nuestro propósito es de asistir y motivar estudiantes a que tengan éxito en graduarse de la preparatoria, inscribirse y completar una educación universitaria de su preferencia. Nuestro programa Upward Bound ayudara en varias maneras a un total de 50 estudiantes de la preparatoria Central y South Mountain. También ayudaremos a su hijo/a a mejorar sus habilidades académicas con curso particular después de escuela por lo menos una vez por semana. También ayudaremos a su hijo/a a mejorar sus habilidades personales con sesiones de enriquecimiento tales como habilidades de estudio, administración de tiempo, exploración de carrera, pensamientos críticos, y planes individuales de éxito para las universidades.

El programa Upward Bound es programa federal y se requiere que los participantes cumplen con los requisitos que están estabilizados por el Departamento de Educación. Participantes deben de ser estudiantes de bajos ingresos y primera generación que va asistir al colegio. Por esta razón, estamos pidiendo la información siguiente “Padre/Guardián Formulario de Información” al repuesto del nivel educativo y ingreso de hogar. También requerimos una copia firmada con los más recientes impuestos federales. Esta información se mantera confidencial y solamente estará utilizada para seleccionar estudiantes y estadísticas.

El programa Upward Bound de South Mountain esta trabajando juntamente con la escuela preparatoria y consejero académico de su hijo/a. En orden de ayudar a los estudiantes es importante que nuestros empleados tengan acceso a los expedientes académicos para determinar qué tipo de ayuda es necesaria para mejorar los estudios de su hijo/a. Su firma en el formulario “Padre/Guardián Formulario de Información” va permitir acceso a los expedientes académicos escolares. Esta información será estrictamente confidencial.

Su hijo/a es responsable de completar el formulario”Student Application and Personal Statement.” Y usted esta encargado de cumplir y firmar con en formulario “Padre/Guardián Formulario de Información.” Finalmente necesitamos que el consejero académico/profesor de su hijo/a complete el formulario “Counselor/Teacher Referral Form”. La aplicación debe de estar completada y entregada en la oficina del consejero académico de su hijo/a a la oficina de TRIO en South Mountain Community College.

Si usted tiene preguntas sobre este programa o quiere mas información, favor de llamar al (602)305-5676.

Sinceramente,

Laura Smith

Upward Bound Coordinator

South Mountain Community College

Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

South Mountain Community College

Upward Bound

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Parent/Guardian Information

GUARDIAN # 1 GUARDIAN # 2

Name: Name:

(first) (last) (first) (last)

Address: Address:

(street or P.O. Box) (street or P.O. Box)

(city) (state) (zip) (city) (state) (zip)

Phone: ( ) Phone: ( )

Occupation: Occupation:

Employer: Employer:

Relation to applicant: Relation to applicant:

( Natural parent ( Adoptive parent ( Natural parent ( Adoptive parent

( Step parent ( Guardian (specify) ( Step parent ( Guardian (specify)

_________________ ______________

Does the student currently live with you? Does the student currently live with you?

( Yes ( No ( Yes ( No

Do you have a Bachelor’s Degree? Do you have a Bachelor’s Degree?

( Yes ( No ( Yes ( No

Income Information – Please fill out section A OR B

************************************************************************************************************

A) If you FILED TAXES, fill out this section:

Filing Status: ( Single ( Married, filing jointly ( Married, filing separately ( Head of Household

TOTAL number in household including parents and siblings: ____________

Family Annual Taxable Income: $______________

**Please attach a SIGNED copy of your MOST RECENT tax returN FOrms.**

B) If you DID NOT FILE TAXES, fill out this section:

I (we) did not and will not file a Federal Income Tax Return, IRS form 1040, 1040EZ, or 1040A for the reason(s) checked below.

TOTAL number in household including parents and siblings:

In the last tax year, my family received $______________ each month from (check all that apply):

• Child Support ________ ( Federal Agency (Specify):

• Company (specify) ( Other (specify) ______________

• State Agency (specify) ______________

Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

South Mountain Community College

Upward Bound

Parent/Guardian Permission Form

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Permission to Participate

If selected, this is to authorize permission for my son/daughter to attend

and participate in the Upward Bound Program after school tutoring, personal mentoring, and weekly lunch time enrichment sessions during the school year. I also give him/her permission to attend the Saturday Academies twice a month during the school year, the spring break college orientation trips, the 6-week summer program at South Mountain Community College, and our Summer Residential Program at Northern Arizona University.

Release of Educational Information

If selected, this is to authorized permission for the Upward Bound program to obtain school documents relative to and consistent with my child’s education. Such documents may include, but are not limited to: official transcripts, grade point average, ranking in class, standardized test scores including the AIMS, PLAN, PSAT, his/her middle school transcripts, class schedules, school lunch program eligibility, and any other information used to determine academic, career, or college progress.

Student Name: _____________________________________________

I (we) give permission for the above named student to have permission to participate in the Upward Bound Program at South Mountain Community College, as well as permission to release educational information as explained in the statements above.

___________________________________ ____________________________________________

Parent/Guardian Name Parent/Guardian Signature Date

___________________________________ ____________________________________________

Parent/Guardian Name (optional second signature) Parent/Guardian Signature Date

South Mountain Community College, TRIO Programs

7050 South 24th Street, Phoenix, AZ 85042 (602) 305-5676

Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

South Mountain Community College

Upward Bound

Counselor/Teacher Referral

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Dear Counselor/Teacher:

The Upward Bound Program at South Mountain Community College is a FREE college preparatory program funded by the United States Department of Education. Our purpose is to assist and motivate students to succeed and graduate from high school, and enroll and complete a postsecondary education of their choice. Our Upward Bound Program will serve a total of 50 students from Central and South Mountain High Schools in a variety of ways.

We will be helping your student(s) improve their academic skills through weekly tutoring after school, as well as classes in math, science, English, foreign language, and study skills every other Saturday during the school year and the 6-week summer program at South Mountain Community College. The Upward Bound program is federally funded and it is required that a majority of the participants meet guidelines set forth by the Department of Education. Participants must be either low income or potential first-generation college students.

Due to the limited number of participants we are allowed to serve we are asking students to complete an application. The applicant will complete the “Student Application and personal statement” section of this application. We are asking their parent/guardian to complete the “Parent/Guardian Information” and we are asking you to fill out the “Counselor/Teacher Referral”. This referral form will aid us in our selection process. We ask that you complete the form and return it in a sealed envelop to our Upward Bound on-site contact’s mailbox:

• Counseling Office @ Central High School

• Counseling Office @ South Mountain High School

If you have any questions regarding this program or if you would like to recommend a student to the program, please feel free to contact the Upward Bound office at (602) 305-5676. Thank you for your assistance and we are looking forward to working with your students!

Sincerely,

Upward Bound Program

South Mountain Community College

Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

South Mountain Community College

Upward Bound

Counselor/Teacher Referral

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Student Last Name: __________________First: ___________________________ Student ID _______________

Name of School: ___________________ Referring Counselor/Teacher (include subject): _______________________

1. Does the applicant have the desire to pursue a post-secondary education? (Yes) or (No)

2. Would the applicant benefit significantly from academic support beyond that provided in the

high school? If yes, please check all academic areas that apply.

English Composition/Literature___ Mathematics ___ Science ___ Foreign Language ___

English as a Second Language____ other subjects: _____________________________________

3. Is the applicant on track to graduate with his/her class? (Yes) or (No)

4. What is the expected high school graduation date? _______________

5. Does the applicant have a good attendance record? (Yes) or (No)

6. Does the applicant have a discipline problem in school? (Yes) or (No)

7. Has the applicant passed the math proficiency test required by the district? (Yes) or (No)

8. Has the applicant passed the reading proficiency test required by the district? (Yes) or (No)

9. What is the applicant’s current cumulative GPA? _________ Grade Level: _______________

Please provide any additional comments that will assist TRIO personnel in the selection process.

Referring Counselor/Teacher Signature: ____________________________________ Date: ____________

Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

Upward Bound Success Plan

Name ____________________________ Date___________ Central HS South Mountain HS

*What are you good at? What are your talents and gifts?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

*What have you done in the past that you really enjoyed?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

*If you could do anything in the world, what would it be?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

*When are you the happiest?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

*What are your favorite subjects?

___________________________________________________________________

___________________________________________________________________

Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

*How is your home environment? Who do you live with?

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

*If you were wealthy, but still chose to work, what would you do?

______________________________________________________________________

______________________________________________________________________

*What/Who motivates you?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

*What is your proudest accomplishment?

_______________________________________________________________________

_______________________________________________________________________

*What are your greatest strengths?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

*Do you have a support system? If so, who is in it?

_______________________________________________________________________

_______________________________________________________________________

Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

*Do you have any financial concerns (now or paying for college)?

_______________________________________________________________________

_______________________________________________________________________

*List three career/academic goals (long term or short term).

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

*List three personal goals (long term or short term).

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

*What do you want to be/major in?

_______________________________________________________________________

_______________________________________________________________________

*What colleges interest you?

_______________________________________________________________________

_______________________________________________________________________

*What are your academic concerns?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

*What actions are you going to take to overcome these?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

*What are your personal concerns?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

*What actions are you going to take to overcome these?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

*How are your skills in the following? (Need improvement, Good, Great, etc)

-test taking________________________________________________

-note taking_______________________________________________

-concentration_____________________________________________

-memorization_____________________________________________

-time management__________________________________________

-procrastination____________________________________________

*Other concerns

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Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  .

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