Winter Math Bridge Program Application

Please complete and submit this application to be eligible to participate in the Winter Math Bridge Program.

For more information, contact Christina Bavone at christinabavone@triton.edu or Derek Salinas-Lazarski at dsalinaslazarski@triton.edu.

* =required

Student Information

First Name *

Last Name *

Birth Date *

Street Address *

City *

State *

Zip Code *

Phone Number (preferred contact) *

Email Address *

General Information

How would you prefer to attend this program? * In-person (On Triton College Campus) Remotely Hybrid (Combination of In-person and Remote)

How did you hear about us? (Fill-in-the-blank) *

Computer Access

In the event this program is held remotely, access to a computer is important.

Do you have access to a computer? * Yes No

Do you have access to an Internet connection? * Yes No

Program Requirements

Winter Math Bridge Program participants must agree to the following requirements:

I understand that this program is only available to new Triton College students enrolling in spring 2023.
I agree to enroll at Triton College in spring 2023.
I commit to attend all program meetings and participate in all program activities.
I agree to abide by all requirements of the program.
I agree to engage in online, remote learning for the duration of this program using a computer and internet connection if applicable.
I allow Triton College to use photographs of me from the program.
I agree to sign and return a Hold Harmless Form on the first day of this program.

Signature Verification

To verify and complete the submission of this application the student must complete the student signature and date information.

If the student is under 18, a parent/guardian must also verify and complete the parent/guardian signature and date information.

This form will not be considered valid without the required verification(s).

Student Verification

Upon completing the student signature and date information, I agree to abide by the program requirements in order to participate in this program.

Student Signature *

Date *

Parent/Guardian Verification (if applicable)

Upon completing the parent/guardian signature and date information, I give consent for my student (if under 18) to participate in this program and adhere to program requirements.

Parent/Guardian Signature

Date

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