APASS Interest Form | Asian and Pacific American Student Success

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First Name

Middle Initial

Last Name

Personal Email

Phone Number

Date of Birth

Address

City/Town

State/Province

ZIP/Postal Code

Current or Last High School Attended

Year Graduated or Completed GED/HiSET

What is your major - what do you want to study?

What is your career choice - what do you see yourself doing after finishing school?

What is your Financial Aid Status?

I have completed FAFSA or Dream Act application.

I have Not completed FAFSA or Dream Act application.

I don't knowhow to complete FAFSA or Dream Act application.

Will you be working while in school? If so, how many hours a week?

What do you anticipate as your biggest challenge in college?

Time management

Money management

Study skills

Taking classes online

Other

What is your ethnic background? (e.g. Vietnamese, Chinese, Samoan, Mexican, Multiracial)

What is the primary language spoken in your home?

Has anyone in your family attended college?

Yes

If yes, who?

Please tell us about yourself, your family, academic goals, career interests, hobbies, extracurricular activities, and anything about yourself you believe we should know. Additionally, please tell us what you have to offer our program and how you think you will benefit from participating in the APASS Learning Community.

How did you learn about the APASS Learning Community?

High School Counselor/Teacher

SRJC Counselor/Faculty/Staff

Outreach Event

Family/Friend

Other