2018 CCLI Program Application Current APPLICANT Family Data ESSAYS TRANSCRIPTS ACKNOWLEDGEMENT Complete I. APPLICANT Please type or print clearly and use your full legal name. First Name Middle Name Last Name Grade Level for Fall 2018 - Select -11th12th Name of School Attending in Fall 2018: (Use full name. Ex: Carl Hayden Community High School) Address of High School School District Name: (If charter or private school, write “Charter” or “Private”) Expected HS graduation date Applicant E-mail address Applicant Cell Phone (if applicable, please use format xxx-xxx-xxxx) Applicant Home Phone Address City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Birth date (mm/dd/yyyy) Gender - Select -MaleFemale Race/Ethnicity: (Check all applicable) White/Caucasian Asian American/ Pacific Islander Latino/Hispanic American Indian/ Native Alaskan Black/ African American Other T-Shirt Size (Adult) - Select -SmallMediumLargeX LargeXX Large Are you a first generation college student? (First Generation College Student: Neither parent has a Bachelor’s degree) - Select -YesNo Do you receive free/reduced lunch? - Select -YesNo How did you hear about the César E. Chávez Leadership Institute (CCLI)? Select all that apply. Parent/Student Info Session CCLI Participant Recommendation Teacher/Counselor/Principal Recommendation Flyer Email from ASU Email from school Other. Please Specify: Others Leave this field blank