Preferred Name First name * Last name * Birthdate * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Preferred phone contact * - Select -HomeWorkMobileOther Home phone Cell phone Student email address * Emergency contact name(s) * Emergency contact phone number * Street address * City * Zip code * How did you hear about SPOT 127? - None -RadioOnlineSocial MediaSchoolFriendOther Are you a returning student? Yes No Which SPOT 127 location will you be attending? - None -Spot 127 East ValleySpot 127 West Valley Which session will you be attending? * Level 1 - Beginner Level 2 - Advanced Grade * - Select -89101112 What is your GPA? Please enter your GPA as a 2 or three number decimal (ex. 3.33) School name * High school graduation date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202220232024202520262027 Parent/Legal guardian name(s) * Parent/Legal guardian phone number * Parent/Guardian email * Parent/Guardian level of education - None -Less than High SchoolHigh School/GEDSome CollegeAssociate's DegreeBachelor's DegreeGraduate Degree Do you live with both of your parents? Yes No Persons in Family * 123456789101112131415 Family's Annual Income is less than - None -I don't know$17,420$21,960$26,500$31,040$35,580$39,750$46,560$53,370 Is your family's income less than $20,385? * Information about family income allows us to apply for special funding. yes no Identified gender - None -MaleFemaleOther Identified ethnicity * - Select -Hispanic or Latino or Spanish OriginNot Hispanic or Latino or Spanish OriginI prefer not to answer Identified race (please select one) * Multiracial American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White I prefer not to answer Likelihood of attending college - None -Not likelyModerately likelyExtremely likely Colleges of interest Food will be provided daily (West location only). Do you have any food allergies? Yes No If you answered yes to food allergies, please list the food(s) to which you are allergic. What excites you about digital media? * Please describe in at least three sentences. What do you want your future to look like? * Please describe in at least three sentences. Final Step: Orientation Form Important: Directly after submitting this form, please be sure to fill out the mandatory orientation form. If no orientation packet has been received with this application, the application will automatically be void. Orientation Form Acknowledgement * I acknowledge that I will complete the mandatory orientation form.