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Contact Us
Home
Welcome
About
Fast Facts
Program Overview
Course Descriptions
Admissions
Donate
Calendar
Partners
Sponsors
Photo Gallery
Contact Us
Name
*
Name
First Name
Last Name
Address
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How long have you lived at this address?
How is permanent residence established?
Address of person living with
Place of registration to vote
Family's primary residence
Phone
Phone
(###)
###
####
Email Address
*
Date of Birth
I am a
U.S. citizen
U.S. national
Resident alien
If you checked Resident Alien, fill out your VISA#
Are You a Veteran?
Yes
No
Which Branch?
Educational History:
High School Diploma
GED
Some Post High School
College Graduate and above
Vocational or Technical Training
Less than High School (last
List awards, scholarships, publications or special recognitions you have received. List in descending order of significance.:
Explain why you should be considered for a scholarship to Excel:
What additional personal information do you wish to share with the Excel scholarship committee?
Driver License Information:
Do you have a valid driver license?
Yes
No
If yes, what is the driver license number?
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
Have you ever been charged with a traffic violation?
Yes
No
If yes, list any traffic violations and points you have on your driving record
Thank you!