Online Registration
You must complete all the fields with asterik.

Basic Information

          
First name *   Last name *   Middle Initial  
     
Date of Birth *   Gender *
 

Current Address (please include apt number in street address)
Address: *
City: * State:* Zip: * -

Contact Information (A home phone number and an email address is required)
Home Phone: * ( ) -        
Cell Phone: ( ) -        
E-mail: *
Alternative E-mail:
Parent E-mail:
Underrepresented or First Generation College Bound? (You must check at least one.) *
I am a member of an historically underrepresented group (African American or Black, Native American or Alaskan Native, Mexican or Mexican American, Hispanic, Latino, or Puerto Rican).
I am a first generation college bound student whose parents/guardians have no education beyond high school. Race and ethnicity are not factors.
Ethnicity (You must check at least one) *











Religion: *


Career Major: *


High School Graduation Date: *


CEEB Code *  Click here to look up code in a new window


Current GPA:   Class Rank: I am out of a class of
        (number)   (number of students in graduating class)
Standardized Test Scores *
Please indicate the tests you have taken, and record the test date, and scores for each exam.

PSAT
Date Taken Math Verbal  
 
PLAN
Date Taken Composite Math English Reading Science
SAT
Date Taken Math Critical Reading
 
ACT
Date Taken Composite Math English Reading Science

Please indicate the highest level of your parents' or legal guardian's educational background:
Mother/Legal Guardian:







Father/Legal Guardian:








Please indicate, for the most recent year, the range of your family's gross income as reported on the Federal and/or State Tax Return.
Less than $10,000
$10,000 - $19,999
$20,000 - $29,999
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 - $69,999
$70,000 - $79,999
$80,000 or more

Please select the math class you are currently taking. If you are not currently taking a math class, please select the highest level course you have completed. *









Please select the science class you are currently taking. If you are not currently taking a science class, please select the highest level course you have completed.





AP Courses






































Are you taking IB or have you completed (International Bacalaureate) courses? * Are you taking or have you completed any college level courses? *





What extra curricular activities have you participated in?













You must check the following in order to take advantage of the Ventures Scholars Program opportunities:
* I certify that this information is complete and correct to the best of my knowledge.
* I authorize the Ventures Scholars Program to provide my information to colleges, universities, and associations that will help me pursue my career goal.



 
 
© 2010 Ventures In Education, Inc.