Apply - DiverseNote Mobility

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Race / Origin *

Gender *

Date of Birth *//

Highest level of education. *

Applicants are requested to answer the next two questions voluntarily.

Are you a veteran of the U.S. Military?

Do you have a disability?

What program are you applying for? (View academic program information at https://diversenote.mobi/programs) *

Are you interested in Dual Enrollment?

Learn more about dual enrollment at https://diversenote.mobi/dual-enrollment

Online or In-person training? (copy) *

What schedule are you interested in? *

Weekday Morning (9AM-12PM)
Weekday Afternoon (1PM-4PM)
Weekday Evening (6PM-9PM)
Weekend Morning (Saturday and Sunday 9AM-12PM)

When would you like to start? *

Spring - between April and May 2023
Summer - between June and August 2023
Fall - between September and November 2022
Winter - between December 2022 and March 2023

Why would you like to enroll in a DiverseNote Mobility Program? *

What tuition payment option do you qualify for? *

Are you currently or have you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution? *

Yes
No

Remaining Questions

The remaining questions in this application can be answered later. If you wish to respond to the questions below at a later time, be sure to review and agree to the terms at the bottom of the application and click submit before you exit the application.

High School Information

If you are a current high school or GED program student, please complete this section.

High School Name

Expected Graduation Date

Please provide the names of people in your immediate family who have attended DiverseNote Mobility.

Name

First

Last

Relationship

Extracurricular, Personal and Volunteer Activities

Extracurricular Activities

List your organizations, position, description of the activity, and hours per week of involvement.

Talents and Awards

List each, a description, the level, and number of years of involvement.

Community Service Work

List the type of work, your role, and hours per week of involvement.

Employment

List the job, your title, description, hours per week, and dates of employment.

Attach an additional Word, PDF or text document if necessary.

Click or drag a file to this area to upload.

Household Information

This information is required if you are under 26 years old.

Father or Legal Guardian Occupation

Father or Legal Guardian Education

Mother or Legal Guardian Occupation

Mother or Legal Guardian Education

Please indicate your family’s gross income for the most recent tax year. Include both taxed and untaxed income.

Do you have family obligations that keep you from participating in extracurricular activities?

No
Yes, I have to work to supplement family income.
Yes, I provide primary care for family member(s).
Other

If yes or other, please describe:

For Non-U.S. Citizens Only

City and Country of Birth

Agreement

I understand that this application is for admission only for the term indicated. I agree that I am bound by the Academy's regulations concerning application deadlines and admission requirements. I agree to the release of any transcripts and test scores to this institution, including high school and/or college GPA, reading and math level, any SAT, and/or ACT score reports. I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or residency statement may result in disciplinary action, denial of admission and invalidation of credit or degrees earned. If admitted, I agree to abide by the policies of the Board of Regents and the rules and regulations of the Academy. Should any information change prior to my entry into the Academy, I will notify the Office of Admissions.

Do you understand and agree to the terms listed above? *

Yes, I understand and agree to the terms listed above.

Events, activities, programs and facilities of the Academy are available to all without regard to race, color, marital status, gender, religion, national origin, disability, age, nor veteran status as provided by law and in accordance with the Academy's mission of all-inclusive diversity.

DiverseNote Mobility Program Application