Gateway to College - Scholarship Application

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Gateway to College

Shasta College
11555 Old Oregon Trail

P.O. Box 496006

Redding, CA 96049-6006
530-242-7585

Program Application

Please read the application carefully and print clearly. Complete the entire application including signatures and attach your most recent transcript.

Please do not use a school email address that you may lose access to.

Student Information

Full Legal Name:

Current School:

Grade Level:

Student Email:

Contact Phone:

Cell or Home Phone?

Mailing Address:

Apartment/Space #:

City:

State:

Zip Code:

File Attachments:

Personal Information

Date of Birth:

Current Age:

Gender:

Birthplace City:

Birthplace State:

Birthplace Country:

Are you currently in foster care?

Were you in foster care anytime between the ages of 16 and 18?

Who do you currently live with?

Relationship to you:

Parent Information

Parent/Guardian First Name:

Parent/Guardian Last Name:

Relationship to you:

Parent/Guardian Phone: #1:

Cell or Home Phone?

Parent/Guardian Phone: #2:

Cell or Home Phone?

Mailing Address:

Apartment/Space #:

City:

State:

Zip Code:

Parent/Guardian Email address (to receive important notices):

Please type your Parent/Guardian's email a second time to verify accuracy:

Additional Contact Information: List emergency contacts if different than parent/guardian above.

First Name:

Last Name:

Agency (if applicable)

Relationship to you:

Contact Number:

Cell or Home Phone?

First Name:

Last Name:

Agency (if applicable)

Relationship to you:

Contact Number:

Cell or Home Phone?

Academic Information

Are you behind in high school credits?

Have you ever had an IEP?

Have you ever had a 504 plan?

Have you ever been expelled or suspended from a school or college?

Are you on probation?

Are you eligible for the Free/Reduced School Lunch program at school?

Do you typically participate in the school lunch program?

How do you typically get to school?

School Bus

Ride from Parent/Friend

Walk

Drive

RABA

Other

Are you familiar with riding the RABA bus system?

Have you ever had a SARB contract?

Are you able to attend class 5 days a week?

List all high schools or alternative education programs you have attended:

Once you have completed this form, please click submit. If the submit button is not available, double check that you have entered the parent/guardian email address correctly.

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