College Readiness RHT-099 HS Application

* = required

Student Information

First Name *

M.I.

Last Name *

Street Address *

City *

State *

ZipCode *

Phone Number * (Preferred Contact)

Alternate Phone Number

Email Address *

Birth Date *

Gender *

Citizenship Information

Citizenship (Check Only One) *

Non-Citizen: Status Indentified Instructions

Non-citizen: status identified - this should only be checked if you can answer "yes" to all of the following questions:

Did/will you graduate from an Illinois high school or attain a GED in Illinois?
Did/will you attend a school in Illinois for at least 3 years during K-12?
Did/will you live with your parents while you attend(ed) school in Illinois?

U.S. Permanent Resident Instructions

Provide additional information if U.S. Permanent resident is checked:

Country of origin
Alien registration number

Permanent Resident, Country of Origin

Permanent Resident, Alien Registration Number

International Citizen Instructions

Provide additional information if International is checked:

Country of origin
Visa category

International, Country of Origin

International, Visa Category

About Me

My primary reason for attending Triton College is: *

What is the highest level of education attained by your Mother? *

What is the highest level of education attained by your Father? *

My current employment status is: *

Compliance

NOTE: This information is requested solely for the purpose of determining compliance with federal civil rights law, and your response will not affect consideration of your application. By providing this information, you will assist us in assuring that this program is administerd in a non-discriminatory manner.

Are you Hispanic or Latino? * Yes No

Are you from one or more of the following racial groups (check all that apply) * American Indian/Alaskan Native African American/Black Asian Native Hawaiian/Pacific Islander White No Response

Primary racial/ethnic group: (check one) * American Indian/Alaskan Native African American/Black Asian Native Hawaiian/Pacific Islander White No response

Parent/Guardian Verification

Note: Parent/Guardian consent required for completion and successful submission of application.

I, the parent/guardian of the listed student verify my consent to their participation in the College Readiness program for High School students at Triton College.

Student Name *

Parent/Guardian Name *

Parent/Guardian Verification and Consent * Yes

FOR OFFICE USE ONLY

Triton College Course Title	Semester Hours

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College Readiness RHT-099 HS Application