El Paso Community College CCA-FOCUS Fall Application : Center for Mathematics Readiness : Texas State University

This is an application for admittance into the FOCUS program. If you are accepted to the FOCUS program and agree to participate, registration information will be provided to you. You must be available to come to the El Paso Community College campus for pre-assessments. The FOCUS program does NOT pay for tuition and fees.

Please familarize yourself with the CCA-FOCUS Student Expectation Agreement in your school.

Selection for Fall 2013 semester:

CCA-FOCUS

Please fill out as much of the form as you can. Any areas left blank may cause the reviewer to REJECT the application.

Check the semester you are applying for: *

Fall 2013

Which campus are you attending? (if different from main campus)

Which CCA-FOCUS Course are you applying for? *

CCA-FOCUS Course - TBA (contact your school for details)

Date: *

Last name: *

Middle initial:

First name: *

Date of birth:(mm/dd/yyyy) *

Student ID: *

Email Address: *

All applicants must provide a contact phone number and a local address below.

Phone number with area code *

Street address *

City *

State *

Zip code *

All applicants 18 or younger must provide their guardian information below. If you are over 18, then please fill in the "older than 18" section. Failure to fully complete either section can result in rejection of the application by the reviewer.

Participants 18 or younger:

Guardian Last Name:

Guardian First Name:

Guardian e-mail Phone

Guardian Street Address:

City:

State:

Zip code:

Participants older than 18:

Permanent e-mail Phone

Permanent Street Address:

City:

State:

Zip code:

Gender: *

Male

Female

Are you an international student? *

Yes

No

Ethnicity (if other, please fill in the field) *

American Indian/Alaskan Native

Asian/Pacific Islander

Black, Non-Hispanic

Hispanic

White, Non-Hispanic

Non-Resident international

Other:

Native language (if other, please fill in the field) *

English

Spanish

Other:

Check the high school plan graduated under. *

GED/ASE

High school diploma

Year high school diploma, GED/ASE was received. *

School district (Type N/A if you received a GED/ASE) *

Name of high school (Type N/A if you received a GED/ASE) *

City of high school (Type N/A if you received a GED/ASE) *

State of high school (Type N/A if you received a GED/ASE) *

List all MATHEMATICS courses taken from high school to now.

	Class name:	When the class was taken (grade level in high school or year in college):	Where the class was taken:
1:
2:
3:
4:
5:

What is your major? *

If other (please specify):

Please describe why you should be considered for the program(100 words or less). *

Please describe how you will show your commitment to this program(100 words or less). *

Please provide a nominating reference: (A nominating reference can be anyone who can attest to your commitment to the program but please exclude family members.)

Name: *

Title and organization: *

Relationship to reference: *

Phone number: *

Email: *

If other, please specify:

Consent (English)

El Paso Community College and the Texas Higher Education Coordinating Board are using student data to evaluate the effectiveness of this program. All data is confidential. It will be reported only in the aggregate and for the express purpose of measuring and reporting on the effectiveness of this program.

I understand that any such information will be used by El Paso Community College and the Texas Higher Education Coordinating Board only for these purposes, that El Paso Community College and the Texas Higher Education Coordinating Board will not disclose any such information that personally identifies a student to any other party, and that any report generated on the basis of this information will not personally identify any student.

Consentimiento (Español)

El Paso Community College y la Junta Coordinadora para la Educación Superior en Texas están usando los datos de los estudiantes para evaluar la efectividad de este programa. Todos los datos son confidenciales. Sólo serán informados de manera agregada y con la finalidad expresa de medir e informar la efectividad de este programa.

Yo/Nosotros comprendemos que dicha información será usada por El Paso Community College y la Junta Coordinadora para la Educación Superior en Texas solamente para estos fines, que El Paso Community College y la Junta Coordinadora para la Educación Superior en Texas no darán a conocer a ninguna otra parte, ninguna información que identifique personalmente a un estudiante, y que cualquier informe generado en base a esta información no identificará personalmente a ningún estudiante.

Agree/Acepto

Disagree/No Acepto

Last Updated 04-01-2013

Department of Mathematics

Center for Mathematics Readiness

CCA-FOCUS

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El Paso Community College CCA-FOCUS Fall Application

All applicants must provide a contact phone number and a local address below.