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Eligibility Application 2

Eligibility Application

This is the last step in our selection process. Please fill out this form accurately and honestly.

Step 1 of 5

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Student Information
Portrait Photo(s)*
Include two photos of yourself. Say Cheese!
Drop files here or

Max. file size: 5 MB, Max. files: 2.
Name*
First Last
Home Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Email*
Cell Phone*
Date of Birth*
MM slash DD slash YYYY
Social Security or National Insurance #*
Age*
Sex*
- Male
- Female
Disability Status*
- No
- Yes
(check any of the following that apply)*
Ethnicity*
- Hispanic or Latino, for a person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture of origin, regardless of race
- Not-Hispanic or not-Latino
Race*
- American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America).
- Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent.
- Black or African-American. A person having origins in any of the black racial groups of Africa.
- Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
- White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
Personal History
Are you an 'only' child?*
- Yes
- No
Your birth order*
# of sisters*
Grew up in the same house.
# of brothers*
Grew up in the same house.
Are your parents divorced?*
- Yes
- No
What parent do you currently live with?*
- Mom
- Dad
Were you adopted?*
- Yes
- No
When were you adopted?*
MM slash DD slash YYYY
Short Biography*
What's your story? What events brought you to this point in your life?
Social Development*
What experiences have contributed to your social development? Note any challenges, problems or issues with this development as well.
Emotional Development*
What experiences have contributed to your emotional development? Note any challenges, problems or issues with this development as well.
Psychological Development*
What experiences have contributed to your psychological development? Note any challenges, problems or issues in this development as well.
Physical Development*
What experiences have contributed to your physical development? Note any challenges, problems or issues in this development as well.
Pertinent Health Records
Please attach any pertinent health records (Social, Emotional, Psychological, Physical)
Drop files here or

Max. file size: 2 MB, Max. files: 15.
Parent Name / Financial Guarantor
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Relationship to Student*
Father, Mother, Grandfather, etc
Occupation / Company*
Home Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Cell Phone*
Home Phone*
Work Phone*
Email*
Other Parent Name
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Relationship to Student*
Father, Mother, Grandfather, etc
Occupation / Company*
Home Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Cell Phone*
Home Phone*
Work Phone*
Email*
Other Emergency Contact
Relationship to Student*
Father, Mother, Grandfather, etc
Name*
First Last
Occupation / Company*
Home Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Cell Phone*
Home Phone*
Work Phone*
Email*

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Personal Medical Information
Weight*
Height*
Blood Pressure
Blood Type
Please list all current medications
Please list all known allergies
Medical Contact Information
Physician Name
First Last
Cell Phone
Dentist Name
First Last
Cell Phone
Insurance Coverage Information
Do you have medical insurance?*
- Yes
- No
Do you have dental insurance?*
- Yes
- No
Medical Insurance Information
Medical Insurance:*
Street Address City State / Province / Region ZIP / Postal Code Country
Policy #*
Group #*
Phone*
Scan / Photo / Copy of Medical Insurance Card*
Please scan / photo / copy the front and back of your medical insurance card and upload both files here.
Drop files here or

Max. file size: 2 MB, Max. files: 4.
Dental Insurance Information
Dental Insurance:
Street Address City State / Province / Region ZIP / Postal Code Country
Policy #
Group #
Phone
Scan / Photo / Copy of Dental Insurance Card
Please scan / photo / copy the front and back of your dental insurance card and upload both files here.
Drop files here or

Max. file size: 2 MB, Max. files: 2.
Education
Highest grade completed*
GPA*
What's your educational goals?*
Do you have any learning or reading disabilities?*
- Yes
- No
Please explain

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Employment
How many jobs have you had in the last 3 years?*
- 3 or more
- 2
- 1
- None
Job #1
Most recent job.
Company Name*
Position*
Name of supervisor*
Phone*
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Hourly Pay*
Reason for leaving*
Job #2
Company Name*
Position*
Name of supervisor*
Phone*
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Hourly Pay*
Reason for leaving*
Job #3
Company Name*
Position*
Name of supervisor*
Phone*
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Hourly Pay*
Reason for leaving*

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Finance
What is your credit score?*
Do you have any credit cards?*
Visa, MasterCard, Discover, American Express, etc.
- Yes
- No
How many?*
Do you have any debt?*
Credit cards, Car payments, School loans, etc.
- Yes
- No
What is your total debt amount?*
Do you have a bank account?*
- Yes
- No
How many bank accounts do you have?*
- 1
- 2
- 3
Bank #1
Name of Bank
Total current balance*
Bank #2
Name of Bank
Total current balance*
Bank #3
Name of Bank
Total current balance*

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Transportation
Do you know how to ride a scooter / moped?*
- Yes
- No
Do you know how to ride a bicycle?*
- Yes
- No
Do you have a drivers license?*
- Yes
- No
- Suspended
Why was your license suspended?*
Do you have a car?*
- Yes
- No
Is the title of the car in your name?*
- Yes
- No
What kind of car is it?*
Do you have any tickets?*
- Yes
- No
How many*
Do you have any accidents?*
- Yes
- No
How many?*
Essay: Why do you want to attend Forte Strong?*
Please be as open and honest as possible. This is your chance to speak from the heart and express how you feel. You might want to talk about where you find yourself today, what personal choices may have contributed to your current situation and what you would like to change about it. What you talk about is entirely up to you. Please proof read your work and ensure grammar and punctuation is correct.
Acknowledgement*
By signing below, the Applicant and Parent/Guardian certify that the information in this application is true and accurate to the best of their knowledge. Student and Parent/Guardian understand that if the Applicant is accepted for enrollment and information in this application is determined to be false, inaccurate, or incomplete, the Applicant may be removed from Forte Strong without a refund. Applicant and Parent/Guardian understand that the Applicant can not be guaranteed a enrollment seat without submitting the non-refundable enrollment deposit first.
- I agree to these terms.
Student or Parent Signature*

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