AVID APPLICATION 2015­2016
Student Information Please print neatly in ink. Student’s full, legal name (include middle name): ______________________________________ Gender: _______________Birth Date: ______________________Age: ____________________ Student’s street address: __________________________________________________________ City: __________________________________Zip Code: _______________________________ Phone Number: _________________________________________________________________ School Building: __________________________ Grade Level (2015­16): ________________ Please answer the following questions in your own handwriting. 1. AVID stands for Advancement Via Individual Determination. What does Individual Determination mean to you? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. Why do you want to go to a college or university? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Student Signature: _______________________________________________ Family Information Parent/Guardian Parent/Guardian Name Home Address Home Phone Work Phone Cell Phone Email Address 1. Which ethnic group does the student represent? a.
_____ American Indian or Alaskan Native b. _____ Asian or Pacific Islander c.
_____ Hispanic d. _____ Black, not of Hispanic origin e. _____ White, not of Hispanic origin f. _____ Bi­racial or Multi­racial 2. What language is spoken most frequently in your home? ______________ 3. Parent(s)/Guardian(s) education. Circle the highest level of education completed. Parent/Guardian Parent/Guardian Grade: 5 6 7 8 9 10 11 12 Grade: 5 6 7 8 9 10 11 12 University/College/Tech: 1 2 3 4 University/College/Tech: 1 2 3 4 Master’s Degree Doctorate Master’s Degree Doctorate As an AVID student’s parent or guardian, you must support your child in his or her attempt to pursue the goal of a two­ or four­year college, and serve as an advocate for his or her success. Parent/Guardian Name: _______________________________________________________ Parent/Guardian Signature: ____________________________________________________ Parent/Guardian Name: _______________________________________________________ Parent/Guardian Signature: ____________________________________________________