APPLICATION FOR PARTICIPATION

6268 Mack Rd | Sacramento CA 95823 | Phone 916-821-3989 | Email: sacprepvp@yahoo.com

Application Date

Birth Date

Graduation Year

Last Name

First Name

Middle Initial

Street Address

Apt /STE.

City

State

Zip

Mobile Phone (000-000-0000)

Second Phone 000-000-0000

Email Address

Math Level:

Acedemic GPA

Upload copy of transcript

Standardize Test Score

(Parent/Guardian) Last Name

(Parent/Guardian) First Name

(Parent / Guardian) Email Address

Emergency Contact Name

Emergency Contact Phone

If Yes; Which university did your parent/guardian attend?

If Yes; What is the name of the club or organization?

If Yes; which sport(s)?

What talents, skills, or training do you have to you have? (examples: drawing, singing, painting, acting, leadership, cooking, sports, fishing, speech & debate)

What responsibilities do you have at home?

What help do you or your family need (i.e. job assistance, social services, food, etc)?