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Summer Of Success Program Application

General Information

*1
Full Name:
*2
Date of Birth:
*3
Address: 
4
SPC Student ID (If ):
*5
Home Phone Number:
*6
Cell Phone number:
7
Work phone number:
*8
E-mail Address:
*9
What is your preferred campus to attend for the Summer of Success Program? 
10
Are you a U.S Citizen?
11
Are you a Permanent resident?
12
Are you a Refugee?

Educational Status:

*13
Name of high school attended?
14
First time in College?
15
Have you passed the (FSA) Florida Standards Assessment (All areas)?  
*16
Have you applied for financial aid through SPC?
*17
Did either of your parents graduate from a 4-year college or university with a Bachelor's degree?
18
Do you intend to register a learning or physical disability with SPC's Accessibility Services department?
*19
Please check the programs you have participated in below:
20
If other, please state:
21
Please check the program you have participated in below:
22
What academic areas are you curious about exploring? 

Additional Information:

23
What is your gender?
24
What is your ethnicity?
25
Are you employed?
26
If yes, how many hours a week? 
27
Do you intend to enroll in classes at SPC this fall term?
*28
I certify that the above statements are true and correct to the best of my knowledge. I hereby authorize the Summer of Success Program staff to secure financial and academic information neccessary to determine my eligibility.
 

If you have comments about this survey or questions regarding how to complete this survey, please contact Alexannie Segura-Vargas at Segura.Alexannie@SPCollege.edu or call 727-341-3468.

The Board of Trustees of St. Petersburg College affirms its equal opportunity policy in accordance with the provisions of the Florida Educational Equity Act and all other relevant state and federal laws, rules and regulations. The college will not discriminate on the basis of race, color, ethnicity, religion, sex, age, national origin, marital status, pregnancy, sexual orientation, gender identity, genetic information, or against any qualified individual with disabilities in its employment practices or in the admission and treatment of students. Recognizing that sexual harassment constitutes discrimination on the basis of sex and violates this Rule, the college will not tolerate such conduct. Should you experience such behavior, please contact the Title IX Coordinator and EEO Officer at 727-341-3055; by mail at P.O. Box 13489, St. Petersburg, FL 33733-3489; or by email at eaeo_director@spcollege.edu or spctitleix@spcollege.edu.