Future Five Student Application

Date of Birth*:
Who is your Guidance Counselor?:
Parent / Guardian 1 First Name*:
Parent / Guardian 1 Last Name*:
Relationship to Parent / Guardian 1:
Parent/Guardian 1 Cell Phone Number*:
Parent/Guardian 1 Email*:
What level of education did you Parent/Guardian 1 complete?*:
Parent / Guardian 2 First Name:
Parent / Guardian 2 Last Name:
Relationship to Parent / Guardian 2:
Parent/Guardian 2 Cell Phone Number*:
Parent/Guardian 2 Email:
What level of education did you Parent/Guardian 2 complete?*:
Translator required?:
How many people live in your household total?:
Emergency Contact First Name*:
Emergency Contact Last Name*:
Emergency Contact relationship*:
Phone number of Emergency Contact*:
Are you a permanent US resident?*:
Do you have a job? If so where?*:
Have you ever been convicted of a felony?*:
Do you have any allergies or are you taking any medication?*:
How did you hear about Future 5?:
Will you be a first-generation college student? (the formal definition of a first-generation college student is a student whose parents did not complete a four-year college degree)*:
What High School do you Attend?*:
High School Graduation Year*:
Special Education or IEP*:
Naviance Username:
Naviance Password:
Power School Username:
Power School Password:
Please list any AP's you have taken or are currently taking:
GPA Weighted*:
GPA Unweighted*:
I agree to turn in my Transcript, Report Cards and Class Schedules to Future 5 staff:
I joined Future 5 during my*:
I graduated Here to There:
I am part of Wave*:
A connection is an adult who "has your back." How many connections do you have prior to joining Future 5?*:
Do you follow @futurefive on Instagram?:
Have you downloaded the Future 5 App?:
What is your shirt size?: