Student Information

First Name
Last Name
Preferred Name
Mobile
Personal Email
School Email
Street Address
City
State/Province --None-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming>
Zip
Birthdate
Gender --None-- Male Female Non Binary Prefer Not To Say
Pronouns --None-- he/him/his He/Him/His and They/Them/Theirs other/ask me she/her/hers She/Her/Hers and They/Them/Theirs they/them/theirs
Ethnicity --None-- Hispanic/Latino Non-hispanic/Latino Prefer Not to Answer Unsure
Identified Race (check all that apply)

High School Year of Graduation --None-- 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040
Current School
SDP Student ID
Are your related to anyone at Heights?
Yes

Home Language --None-- Ahmarina Albanian Amharic Arabic Bamana Bangla Belarusian Bengali Cambodian Cantonese Chinese Creole Dari Persian English Filipino French Fujianese Fulani Fuzhounese Garifuna Haitian Creole Hindi Igbo Indonesian Izon Karen Khmer Lao Malayalam Mandarin Mandingo Moroccan Oromo Pashto Patois Polish Portuguese Punjabi Russian Serbo-Croatian Soninke Spanish Tajik Thai Tigrina Tigrinya Twi Ukrainian Urdu Uzbek Vietnamese Wolof Yoruba Other

Household Information

Parent/Guardian 1 First Name
Parent/Guardian 1 Last Name
Parent/Guardian 1 Preferred Name
Parent/Guardian 1 Mobile
Parent/Guardian 1 Email
Parent/Guardian 1 Marital Status --None-- Divorced Married Never Married Separated (Married but living apart) Single Widow/Widower Prefer Not To Answer
Parent/Guardian 1 Relationship to Student --None-- Aunt Child Cousin Coworker Employee Employer Father Friend Grandchild Grandparent Guardian Mentee Mentor Mother Parent Partner/Spouse Referee Reference Sibling Step-Parent Tutee Tutor Uncle
Is PG 1 the best emergency contact?
Yes

Are you a First Generation College Student?
(Select “No” if one or both Parent(s)/Guardian(s) have graduated with at least a 4 year degree from a College/University in the US. Select “Yes” if that is not the case) --None-- Yes No
Household Size
(Number of people in your household including yourself)
Household Income --None-- Less than 20,000 a year Between 20,001 and 35,000 a year Between 35,001 and 50,000 a year Between 50,001 and 75,000 a year Between 75,001 and 100,000 a year Between 100,001 and 115,000 a year Over 115,001 a year No Selection for household income
Are you eligible for Free/Reduced Lunch?
--None-- Eligible For Free/Reduced Lunch Not Eligible for Free/Reduced Lunch Chose not to provide an answer
Does anyone in the household receive Unemployement Benefits?
Yes

Household Supports (check all that apply)

Additional Info
(Please provide the name of the program you are applying for or what you are interested in. If you are not sure, tell us more about your academic, college or career goals. You can also use this space to expand on how you identify your gender, pronouns, ethnicity, race or home languages if those fields were not able to capture all of your information)