Foundation Scholar Form

Student Name *

First Name

Student Last Name *

Last Name

Student Email *

example@example.com

Parent Name *

First Name

Parent Last Name *

Last Name

Parent Email *

Student's Current School *

Student's Current Grade *

Student's Current GPA *

Hometown (please include state/province) *

Ex.: Raleigh, North Carolina

Student Race *

Student Gender *

Total Household Income (current year) *

Please let us know a bit about yourself and your family, and how you feel you would benefit from the mentorship offered to AtomicMind Foundation Scholars on their path toward college admission? [200-350 words] *

Foundation Scholar Program Application

Part 1