SEP Application

Summer Enrichment Program NSHMBA Chicago

SUMMER ENRICHMENT PROGRAM 2011 APPLICATION

Classes begins July 1st to July 30th

Extended day for application June 10th.

If you have troubles filling or sending this application, please email you first name, last name, email, and phone number to: sep@chicago.nshmba.org Thank you.

1. Personal Information
Title
First Name
Last Name
E-mail
Phone
Gender

2. Address Information
Address
City	, IL
Zipcode

3. Education Information
School Name
Grade Level
Current GPA
Expected year graduation

4. Family Information
Father
First Name
Last Name
Phone Number
Education
Mother
First Name
Last Name
Phone Number
Education

Family Members in School

5. Emergency contact
Emergency Contact Name
Phone Number
Relationship

6. Aditional Information
Primary Language
Hispanic Heritage
Generation
Family Income Level
How did you heard about SEP

7. Extracurricular Activities
Name of the organization
Role
Dates of participation

Name of the organization
Role
Dates of participation

Name of the organization
Role
Dates of participation

8. Honors and Awards
Honors/Award
Date Received

Honors/Award
Date Received

Honors/Award
Date Received

9. About SEP by NSHMBA
Why should we accept you?
What do you wish to gain from the SEP?
Wich colleges would you like to attend?
What careerrs would you like to pursuit?

10. Recomendation
Who is recomending you?
Title
Phone
Email

A letter or recommendation is strongly suggested from a teacher or community organization advisor. Please ask the recommender to provide specific examples of your commitment to education and address other reasons he/she believes you should be selected. This letter must be presented by the orientation and interview time.

Please note that all applicants are required to attend one Orientation and interviews will be conducted immediately following the orientation presentation. If you are chosen, you will be contacted by email. If you have any questions please contact us at sep@chicago.nshmba.org.

Good Luck!

Summer Enrichment Program Nshmba

Chicago Chapter

Summer Enrichment Program Nshmba

Chicago Chapter