All information you provide will be kept confidential and will not be shared. Demographic information is used for data and reporting purposes only. Your responses do not affect your eligibility for the program.

Please note: this is NOT a substitute for completion of the Weber State University application for admission.

Contact Info

First Name M.I.
Last Name

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Mailing Street Apt or Unit #
City State AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code

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Primary or Mobile Phone (xxx-xxx-xxxx)

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Personal Email (not your high school or WSU email)

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High School and Weber State Info

How did you hear of the Wildcat Scholars Program?

Upward Bound, GEAR UP, or other college outreach program	WSU mail/email	WSU Advisor
Orientation	Friend	Teacher/counselor
Veterans Services	Other (please specify)

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Select the high school you attended. Please look closely for the name of your high school in this list
Please select... Academy for Math Engineering & Science Alta High Altamont High American Academy of Innovation American Fork High American Preparatory Academy - Draper #3 Ashley Valley Education Ctr. Bear River High Beaver High Beehive Science & Technology Academy Ben Lomond High Big Water School Bingham High Blind Region 2 Blue Peak High Bonneville High Bountiful High Box Elder High Bridges Nebo Transition Center Brighton High Bryce Valley High Cache Alternative High Canyon View High Canyons Technical Education Center Canyons Transition Academy Canyons Virtual High School Capstone Classical Academy Carbon High Cedar City High Cedar Ridge High City Academy Clearfield High Clearfield Job Corps Columbus Community Center Contracted Special Education Copper Hills High Corner Canyon High Cottonwood High Cyprus High Dale Young Community High Davinci Academy of Arts & Sciences Davis High Delta High Desert Hills High Diamond Ridge High School Dixie High Duchesne High East High East Hollywood High East Shore Online Emery High Enterprise High Entrada Escalante High Eskdale High Farmington High Fast Forward High Fremont High George Washington High Grand County High Granger High Granite Technical Institute Grantsville High Green Canyon High School Green River High Gunnison Valley High Herriman High Highland High Hillcrest High Horizon Academy Horizonte Instruction & Training Center Hunter High Hurricane High Independence High Innovations High School Intech Collegiate High School Itineris Early College High Jordan Academy for Technology & Careers - South Jordan Academy for Technology & Careers - North Jordan High Juab High Kanab High Karl G. Maeser Preparatory Academy Kearns High Lake Powell High School Landmark High Layton High Leadership Academy of Utah Lehi High Lighthouse High Logan High Lone Peak High Malan's Peak Secondary Manila High Manti High Maple Mountain High Merit College Preparatory Academy Milford High Millard High Millcreek High Monticello High Monument Valley High Morgan High Mountain Crest High Mountain Heights Academy Mountain High Mountain View High Murray Adult Transition Murray High Navajo Mountain High Nebo Advanced Learning Center North Sanpete High North Sevier High North Summit High Northridge High NUAMES Ogden High Olympus High Orem High Panguitch High Paradigm High School Park City High Parowan High Payson High Pine View High Pioneer High School for the Performing Arts Piute High Pleasant Grove High Polaris High School Post HS Self-Cont Provo Adult Education Provo High Rich High Richfield High Ridgeline High School Riverton High Rockwell Charter High School Roots Charter High School Roy High Salem Hills High Salt Lake Center for Science Education Salt Lake School for the Performing Arts Salt Lake Technology Center San Juan High Sevier Career and Technical Education Center Silver Summit Academy Sky View High Skyline High Skyridge High School Slate Canyon Snow Canyon High South Park Academy South Sevier High South Summit High South Valley School Southpointe Adult High Southwest Educational Academy Southwest High Spanish Fork High Spec. Educ. ATC Springville High St. George Academy Stansbury High Star Transition Success Academy Success DSU Summit Academy High School Summit High Syracuse High Tabiona High Taylorsville High Timpanogos High Timpview High Tintic High Tooele Community Learning Center Tooele High Tuacahn High School for the Performing Arts Two Rivers High Uintah High Uintah River High Union High Utah Career Path High School Utah County Academy of Science Utah International Charter School Utah Military Academy - Camp Williams Utah Military Academy Utah Online 7-12 Valley High School Valley High Vanguard Academy Viewmont High Wasatch High Water Canyon High Wayne High Weber Basin Job Corps Weber High Weber Innovation High School Wendover High West Desert High School West High West Jordan High Westlake High Whitehorse High Winter Sports School Woods Cross High Out of State School Other

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Year of High School Graduation (xxxx)

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Do you have an area of interest for a career or major? Please select... Undecided Business, Accounting, Finance, Management Communication, Media & Marketing Computer & IT, Web & User Experience Education (teaching, outdoor rec education), Child & Family Studies Health & Wellness Mechanical & Electrical Engineering People, Politics, and Society Professional Trades (construction mgmt, auto tech, paramedics, professional sales) Science & Math (not teaching) Visual & Performing Arts (not teaching) Writing, Literature & Languages (not teaching)

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What schedule works best for you?

Monday, Wednesday, Friday about 8:30am - 1:30pm (13 credits, full time)

Monday, Wednesday, Friday about 8:30am - 11:20am (8 credits, part time)

What campus do you prefer for your spring semester classes?

WSU Ogden Campus

WSU Math Placement Level Please select... 0 1 2 3 4 5 6 Find your placement levels in CatTracks

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WSU English Placement Level Please select... 0 1 2 3 4

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Demographics

What is your sex/gender? FemaleMaleOption not listed/Decline

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What is your preferred gender pronoun? Please select... he she they

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What is your date of birth? (MM/DD/YYYY)

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What is your race or ethnicity?

American Indian or Alaskan Native

Asian

Black or African American

Hispanic/Latino (any race)

Native Hawaiian or Other Pacific Islander

White

Other

How long have you lived in the US?
Born in the USMore than 5 years1 - 5 yearsLess than 1 year

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Do you speak a language other than English at home? NoYes

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What is the highest level of education for your mother or parent/guardian 1? Please select... No High School Some High School High School Grad Some College 2-Yr College Grad 4-Yr College Grad Post-Graduate Unknown

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What is the highest level of education for your father or parent/guardian 2? Please select... No High School Some High School High School Grad Some College 2-Yr College Grad 4-Yr College Grad Post-Graduate Unknown

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What is your annual household income? Please select... Less than or equal to $40,000 $40,001 - $60,000 $60,001 - $80,000 $80,001 or higher

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Statement of Interest

List 2-3 reasons you want to come to college.

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Disclaimer and Signature

eSignature: I certify that my answers are true and complete to the best of my knowledge. If this application leads to acceptance to the Wildcat Scholars Program, I understand that false or misleading information in my application may result in my release.

Today's Date (MM/DD/YYYY)

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