Puente Interest Form

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Information about yourself

First Name

Last Name

AHC Student ID/H#

Date of Birth

Street Address

City

Zip Code

Cell Number

Personal Email Address

Information on parent or someone who will always know how to contact you

Name

Address

City

Zip Code

Relationship

Phone Number

Name of High School

High School Graduate?

Yes

No

GED

Other Colleges Attended

College Units Completed (at AHC or other institutions)

Describe Your Career Goal:

Major

Do you plan to transfer to a four-year university?

Yes

No

Don't Know

Are you eligible for financial aid?

Yes

No

Don't Know

Are you eligible for the CA Dream Act?

Yes

No

Don't Know

Are you working while attending school?

Yes

No

If you are working, how many hours per week?

Has anyone in your family attended college?

Yes

No

If someone from your family has attended college, where?

What is your ethnic background? (examples: Mexican, White Non-Hispanic, Chinese, etc.)

Mentoring Questions

Please describe your ideal mentor and expectations for the mentoring relationship

Please list any interests or hobbies that will help us find a mentor for you.

If you have someone who you would like to recommend as a mentor for you, please provide the name and contact information if you have it.

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