Application Form

Title	Mr. Mrs. Miss Ms. Dr. Prof.
First Name
Last Name
Middle Initial
School/Organization/Company
Street Address
City
State/Province	USAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareD.C.FloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingOther (non-US)
Postal Code
Phone
E-mail (give an email you check regularly)
Gender	Male Female
Date of Birth
Place of Birth
How would you describe yourself?	African-American/Black Asian/Asian-American Hispanic-American/Latino Multi-racial Native American-Indian/Alaskan Native Native Hawiian or other Pacific Islander White, non-Hispanic Other
High School Level	Freshman Sophomore Junior Senior
GPA (based on a 4.0 scale)
Mother's Education Level	Some High School High School Graduate Some College College Graduate Other
Father's Education Level	Some High School High School Graduate Some College College Graduate Other
Extracurricular Activities (please list)
Please answer the following essay question (250 word maximum) How would attending the seminar help you in achieving your future goals?
Please list in priority order (1-most important, 2-more important, 3-less important, 4-least important), which of these workshops you would like to attend.
Session I: Identity Workshops (Click here for description)
What does is mean to be Vietnamese American?	1-most important 2-more important 3-less important 4-least important
Model Minority Workshop	1-most important 2-more important 3-less important 4-least important
Session II: Leadership Workshops (Click here for description)
Empowerment of Vietnamese Americans	1-most important 2-more important 3-less important 4-least important
Leadership: What kind of leader are you?	1-most important 2-more important 3-less important 4-least important
Career leadership in the real world	1-most important 2-more important 3-less important 4-least important
Session I: Identity Workshops (Click here for description) (Parents are only invited to Session III Workshops)
How to get into college	1-most important 2-more important 3-less important 4-least important
How to study in college	1-most important 2-more important 3-less important 4-least important
How to pay for college	1-most important 2-more important 3-less important 4-least important
Social aspects of college	1-most important 2-more important 3-less important 4-least important