University of Washington Women s Center Making Connections Program New Student Application

Transcription

1 University of Washington Women s Center Making Connections Program New Student Application

2 Prospective student, Thank you for your interest in the Making Connections program. Making Connections is a high school outreach program offered through the University of Washington Women s Center. This program provides strategies and skills training to help high school students prepare for higher education and explore careers in the science, technology, engineering, and math (STEM) fields. Our mission is to bridge the divide of underrepresented populations in higher education and STEM fields. Making Connections provides students with: Individual academic advising A mentor who supports and encourages you to pursue your aspirations SAT/ACT preparation classes Participation in conferences and college tours Assistance with searching for, editing, and submitting scholarships Education on the college admissions process for students and parents Assistance with essay writing and overall completion of college admission applications Direct assistance in understanding and completing the financial aid process Incomplete applications will not be considered for further review, each student must submit: 1) Complete application (including essays) 2) Current High school transcript (official or unofficial) 3) Parent/Guardian & Student Contract for Participation Please send your application to the following address: Making Connections Program UW Women s Center Box Seattle, WA If you have any questions or need further information, please contact Making Connections Program Manager, Senait O Habte at wcmcp@uw.edu, or by calling (206) Thank you!

3 MAKING CONNECTIONS NEW STUDENT APPLICATION ACADEMIC YEAR I. Student Information Name: High School: Address: City: Zip: Home #: Cell #: Parent Cell #: Student Parent *Please subscribe for an account if you do not already have one. Gender (please circle): Female Male Gender Non-Conforming Other: Cumulative GPA: What grade will you be in during the school year? How did you hear about Making Connections? II. Student Demographics: 1) Yearly household income is (check box): under $22,459 $22,460 - $30,451 $30,452 - $38,365 $38,366 to $46,435 $46,436 to $54,427 over $54,427 2) Including yourself, how many people live in your household? ) Do you qualify for free or reduced lunch? Yes No 4) How many adults are in your household? ) How many adults in your household are employed? ) Who do you live with? Mother Father Both Grandparent Guardian Other:

4 7) Have you taken math courses outside of your requirements? Yes No 8) Have you taken science courses outside of your requirements? Yes No 9) Have you taken technology courses outside of your requirements? Yes No 10) What is your ethnic background? If you identify as multi-ethnic, check all that apply. African/African American/Black Asian /East Asian / South Asian Latinx Native Hawaiian / Pacific Islander Native Indian / Alaska Native Middle Eastern / North Africa White / European 11) Educational background: I will be. Yes No The first in my family to graduate high school The first in my family to go to college A first generation college student (parents don't have 4yr degree) 12) How can the Making Connections Program assist you? Check all that apply. College entrance requirements Financial aid assistance SAT/ ACT preparation College application process Campus visits or college tour Scholarship search Other 13) Is English your primary language? Yes or No 14) Are you currently in English Language Learning or ESL classes? Yes or No 15) How many languages do you speak? One Two Three Four Other 16) What language do you primarily speak at home? 17) Please use the following scale to represent your answers to parts (a) (c): Not Much Some A Lot a) How much do you know about selecting a college? b) How much do you know about applying to college? c) How much do you know about funding for college? 18) Please use the following scale to represent your answers to questions (a) (c): How interested are you in studying Strongly Interested Interested Neutral Disinterested Strongly Disinterested Math Science

5 Technology ) Rate your interest level in the following major or career fields: Strongly Interested Interested Neutral Disinterested Strongly Disinterested Science Technology Engineering Math Law Business Liberal Arts (Creative writing, History, Art) Social Science (Political science, Economics, Communication) 18) Will you require public transportation to and from the women s center? (circle all that apply) Metro Bus Link Light Rail

6 III MANDATORY ESSAYS Each of the following questions must be answered in a short typed paragraph (5 sentences minimum) on a separate sheet of paper. 1. How can Making Connections help you prepare for your future? What are some of your biggest challenges or fears when thinking about college? (Essay, 300 word minimum) 2. Please explain how committed you are to pursuing higher education. (5 sentence minimum) 3. What are some steps that you are taking to reach your goals? (5 sentence minimum) 4. Currently, do you have any obligations that would hinder your participation in this program? (If yes, please explain in a short paragraph) Yes No Making Connections events will include but are not limited to: Making Connections Kick Off Meeting Event Monthly Class Meetings Career Exploration Workshops Parent/Guardian College Informational Fall and Spring Workshops Financial Aid Completion Workshop (Seniors only) Women in Science and Engineering Conference Graduation for Making Connections (all students) Monthly Mentor/Mentee Activities (if paired with a mentor) Weekly Academic Enrichment Sessions (if applicable) Student Mentor Matching Information and Essays: We will work very hard to find you a mentor and this information will help facilitate the matching process. 5. Would you like to be paired with a mentor? Yes No 6. Describe your ideal mentor. (5 sentence minimum). 7. What do you hope to gain from having a mentor? (5 sentence minimum). 8. Please write a short letter introducing yourself to your future mentor. Include: why you want a mentor from the Making Connections program, your talents, hobbies, and career interests. (Note: Your future mentor will read this essay!).

7 UW Making Connections Program Parent/Guardian & Student Contract for Participation Please provide the following information for both the student (front page) and parent/guardian (back page). Student Information Student Name: Please indicate Gender: Male Female Gender Non-Conforming Other: Date of Birth: / / (Month/Day/Year) Medical Restrictions: Yes No If yes, explain: Current Medications: Yes No If yes, please list: Dietary Restrictions: Yes No If yes, please explain: Physician s Name: Phone:( ) Please read through the following list of Participant Expectations and sign below: 1. Students will be asked to participate in Making Connections (MC) Activities. 2. Good attendance is strongly encouraged. MC Staff should be notified of absences from activities in advance, with the exception of emergencies. 3. Parents/Guardians are encouraged to support your students attendance at MC activities. 4. For some activities, MC will offer transportation. MC will use University of Washington vehicles that will be driven by a designated UW staff or volunteer with a valid driver s license. If transportation is not available or if the student chooses not to use transportation offered through MC, then the student is responsible for finding transportation to and from an event. Participants are expected to be respectful of MC staff, property and other attendees. I have read this statement, agree to the expectations, and will abide by them. I understand that if I do not abide by them, or if I am disruptive or disregard the instructions of the University of Washington staff, I may be asked to leave and my parent/ guardian will be contacted. Student Signature Date Parent/Guardian Signature Date

8 Parent/Guardian Information: Please provide the following information (print). Please also read the Parent/Guardian Statement of Consent and provide your signature below. Parent/Guardian Name: Relationship: Address: Street City Zip Day Phone: ( ) Evening Phone: ( ) Insurance Company: Policy Number: If unable to reach above person, please contact: Name: Day Phone: ( Relationship: ) Evening Phone: ( ) Parent/Guardian Statement of Consent My child,, has my permission to participate in the University of Washington s Making Connections Program events and activities I acknowledge that there are certain risks inherent in this program, including but not limited to those indicated in Section 1. I acknowledge that all risks cannot be prevented and I assume those risks beyond the control of the University staff. I represent that my minor child is able, with or without accommodation, to participate in this program, is able to use the equipment and/or supplies described above, and have obtained the required immunizations. Should my minor child require emergency medical treatment as a result of accident or illness arising during the activity, I consent to such treatment. I acknowledge that the University of Washington does not provide health and accident insurance and I agree to be financially responsible for any medical bills incurred as a result of emergency medical treatment. I will notify the activity leader in writing if my minor child has medical conditions about which emergency medical personnel should be informed. I verify that I have read and understood this document and agree to its terms. Parent/Guardian Signature Date

9 PHOTOGRAPHY/VIDEO RELEASE I hereby grant permission to the University of Washington (UW) and its assigns and licensees to take photographs or videos of my child, and to make recordings of my child s voice. I give the UW permission to use these images, videos, and recordings, as well as my likeness, name, and voice, as follows: The use may include reproduction, distribution, derivative works, display, and performance. The use may be in composite or modified forms and in any media, now known or later developed, including without limitation newspapers, television, radio, the World Wide Web, and social media. The use may be for any purpose throughout the world and in perpetuity, including, without limitation, education, trade, advertising, and promotion. I further acknowledge that I will not be compensated for these uses, and that the UW exclusively owns all rights to the images, videos, and recordings, and to any derivative works created from them. I waive the right to inspect or approve of the uses of any printed or electronic copy. I hereby release the UW and its assigns and licenses from any claims that may arise from these uses, including without limitation claims of defamation or invasion of privacy, or of infringement of moral rights or rights of publicity or copyright. This Release is binding on me, my heirs, assigns, and estate. The UW is not obligated to use any of the rights granted under this Release. This Release expresses the complete understanding of the parties. I verify that I have read and understood this document and agree to its terms. Parent/Guardian Signature Date