Early College August 2017

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To be completed by: Qualified scholars @ Early College for 2017 school year

Please answer all questions:

First Name *

Last Name *

Student Cell Phone

Birthdate *

YYYY

Student Grade for 2017 - 2018 *

Emergency Contact (give relation to you) and phone # that we may share information about you and EC. *

The following 7 questions are for gathering statistical information for grants and longitudinal studies for Early College

Student's Gender

Male

Female

Clear selection

Student's Race: Check one OR if multiracial, you may select two or more.

Black or African American

American Indian or Alaska Native

Asian

Hispanic/Latino

Native Hawaiian or other Pacific Islander

White

I will be a first generation college student *

Yes

For the school year, 2017 - 2018 I am ... *

Enrolled in Lanier Tech CERTIFICATE CLASSES

Enrolled in Lanier Tech ACADEMIC CLASSES

Enrolled in University of North Georgia ACADEMIC CLASSES

Required

I have visited / been to a college campus before (other than Early College).

Yes

Clear selection

Mother's schooling achieved

Elementary or middle level

Some high school

High school diploma or GED

2 year Associate's degree or technical degree/certificate

Bachelor's Degree

Master's degree or beyond

Clear selection

Father's schooling achieved

Elementary or middle level

Some high school

High school diploma or GED

2 year Associate's degree or technical degree/certificate

Bachelor's Degree

Master's degree or beyond

Clear selection

Student will purchase (or use free and reduced) breakfast at EC Jones *

Always

Some

Rarely- will bring my own or will eat at my home high school

Student will purchase (or use free and reduced) lunch at EC Jones. *

Always

Some

Rarely - will bring my own or will eat at my home high school

Do you need to use a Hall County Computer? *

No - I have my own to use.

Yes

Required

I have access to Internet at home *

Yes

I am taking an online class in the fall with Early College *

Yes

High School *

I am a work based learning or Honors Mentorship student for fall semester *

Yes

Any special medical information or allergies we should be aware of to help you? (Leave blank if none)

In my free time I enjoy... *

I was a student at Early College last year? *

Yes

I have been successful in school so far: *

Strongly disagree

Disagree

Agree

Strongly agree

My confidence level for taking and being successful in college classes is: (10 is highest) *

My favorite candy or treat is: *

My favorite type of music is: *

Something I am a leader in or good at is _____: *

I wish that I did ___________ better: *

I THINK I may want to be ______ when I graduate from college: *

What else should Mrs. Hood & Mrs. Cookson know about you to support you? *

Any question you wish us to answer? If yes, explain: *

Submit

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