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Student Name

First Name

Last Name

Student Email

Student Cell Phone Number.

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Your class year

Are you a Hartford Youth Scholar?

If You Are NOT an HYS Scholar, Please Let Us Know How You Heard About This Opportunity.

High School Currently Attending

Do You Have a Laptop, Tablet, or Other Electronic Device?

Check all that apply

Laptop/Computer

Tablet

Mobile Device

Parent/Guardian Email Address.

Parent/Guardian Cell Phone Number.

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Please list your top 5 colleges/universities you wish to attend

Your intended major/study

Your career field or career of interest

Have you already started applying for scholarships?

Are you interested in having a scholarship focus planner to help keep track of your applications?

I understand and commit to attending all weekly sessions of the Scholarship Action Lab on Wednesdays 5:45PM-6:45PM.

Yes, I understand and commit to the program.