UC Blue Ash College Bearcat Academy Summer Experience Bridge Program Application (DUE: JUNE 2, 2017)
This success oriented program is for incoming first-year UC Blue Ash students from Cincinnati Public Schools and Norwood High School. Please note that qualified students will be invited to attend on a first come, first served basis up to a maximum of 40 participants.
General Information
Student's Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Student's High School
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Alternate Phone Number
-
Area Code
Phone Number
E-mail
*
Gender
*
Male
Female
N/A
Ethnicity
*
American Indian/Alaska Native
Asian
Black or African American
Caucasian
Hispanic or Latino
Race/Ethnicity Unknown
N/A
Other
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
-
Area Code
Phone Number
Parent/Guardian Address (If different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Information
Emergency Contact Name
*
Their relationship to you
*
Phone Number
*
-
Area Code
Phone Number
Emergency Contact Name
*
Their relationship to you
*
Phone Number
*
-
Area Code
Phone Number
Please list any allergies, physical conditions requiring medication, prescribed medications, or illness:
Academic Information
Have you applied to UC Blue Ash College to begin fall 2017?
*
Yes
No
Have you been offered admission and confirmed admission to UC Blue Ash?
*
Yes
No
Have you completed your UC Math and English Placement Tests?
*
Yes
No
Please provide your UC English Placement Score
*
Please provide your UC Math Placement Score
*
Submit Bridge Program Application
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