Strive Application - Central Oregon Community College

Name (First and Last): *

Birthday (MM/DD/YYYY)*

Mailing Address:*

City*

State*

ZIP Code*

Home phone:

Cell phone:

Email:

Names and phone number of Parents/Guardians:*

What is the best way to contact you?*(Phone, email, parent’s phone, grandma’s phone, etc.)

Do you need transportation from Warm Spring or Madras to Bend for STRIVE?

Yes

No

If Yes, please let us know by Monday June 17. We cannot guarantee transportation after this date.

Do you have access to the internet?

Yes

No

There’s a nearby space where I can regularly go for internet

Do you have access to a computer?

Yes

No

I can borrow or access one regularly

Name of school you are attending: *

Current grade level in school:

Year you expect to graduate from High School:*

Current GPA(this will not affect your acceptance to STRIVE)

Tribal Affiliation:

T-shirt size:

3XL

2XL

XL

Large

Medium

Small

Have you been to STRIVE before?

Yes

No

Gender Identity and preferred pronouns: *

What to you hope to gain by attending STRIVE? *