Pathways Application

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Pathways to Success Application

Name:
Address:
Phone:
-
E-mail:
University or High School
College Major or Future College Major
Current Year in College or High School
GPA
Career or Field of Interest
Below please list any Charitable activities you are currently involved in or have been involved in the recent past and why.
Summarize what you expect to gain from participating in the Pathways to Success Program. Max 250 words

Person to Notify in Case of Emergency


Emergency Contact:
Emergency Address:
Emergency Phone:
-
Emergency E-mail:

Agreement and Signature


Date:
Full Name

Program Participation Requirements

1.    2.5 GPA or higher
2.    Mandatory Orientation attendance
3.    Student should be in good standing with the University or High School
4.    If in College, student should be in good standing with the 100 Collegiate Chapter (i.e. participates in chapter meetings & events)
5.    It is expected that student will attend All Pathways to Success Program meetings, seminars & events including Internship work

Help Make A Difference In the Lives Of Our Youth