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
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