SESP Online Application

Name:

Social Security Number Date of Birth

Race/Ethnicity

Home Address

City State Zip Code

Telephone

Citizenship (if not US or permanent resident, please provide card number

Languages Spoken

Please indicate any language concerns or assistance yo amy need from our office

Health & Diet

Please indicate any medications you take, health concerns, or dietary needs.

Parent or Guardian

Address

High School Name

Address

Please write a two to three page essay on how participating in SESP will help you achieve your educational and career goals. Please include a description of your famil background.

Signature: Student

Signature: Parent