Future Five Student Application









Gender:
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 Number:
Parent / Guardian 2 First Name:
Parent / Guardian 2 Last Name:
Relationship to Parent / Guardian 2:
Parent/Guardian 2 Number:
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?
Lunch:
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)
Ethnicity:
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," someone you can talk to, someone you would go to for advice, someone you trust. How many connections do you have?
Do you follow @futurefive on Instagram?
Have you downloaded the Future 5 App?
What is your shirt size?