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ihope : New Item

Admission Application

Last Name

First Name

Middle Initial

Please indicate your top three (3) Program of Interest.

Program of Interest 1

Program of Interest 2

Program of Interest 3

Are you employed?

Yes
No

Employment Details

How many people live in your household?

*Number of Household members including you.

Single Head of Household

Number of Dependents

Do you have a child under 18? If Yes, click this box.

Do you have a child under 6? If Yes, click this box.

Is there a child that does not have aftercare, or childcare and needs aftercare, or childcare? If Yes, click this box.

Please provide name of each child below and their date of birth:

Child Name

TANF/SNAP Section

Are any of these people living in your household? Please check all that apply:

A child under the age of 18.
A pregnant woman.
An adult who is not the parent, but is a relative caring for a minor child.
You are the parent of a minor child that does not live with you, but are legally responsible for financial support.

OR

Are you receiving SNAP benefits only? If Yes, click this box.

Home Address

City

State

Zip Code

Home Phone or Cell Number

Email Address

Date of Birth

Country of Birth

Which of the following most accurately describes you? You may select more than one.

Asian or Pacific Islander
Black or African American
Hispanic or Latino
Native American or Alaskan Native
White or Caucasian
Multiracial or Biracial
Let me type my race/ethnicity
I prefer not to say

Other Accurate Description

Which gender choice best describes you?

Other gender

Type of High School Diploma

Have you taken College Courses?

Total Credits Earned

Emergency Contact Person's Name

Emergency Contact Person's Phone Number

Emergency Contact Person Relationship to you.

How did you hear about us?

Other how did you hear about us?

Disclaimer

By selecting ‘I agree’ and submitting this form, I certify that the above information is correct to the best of my knowledge. I understand that this information is being provided as a matter of record; it will be kept strictly confidential. I understand that this is an application to be considered for the IHOPE Program and by completing this application, it does not guarantee that I will be accepted into the IHOPE Program.

I authorize this program to obtain copies of my transcripts, test scores, and other materials necessary for participation in the program. I will also grant permission for my photograph, photographic image, and/or video recorded image to be published in materials such as newsletters, annual reports, recruiting presentations, web pages, etc., and release this program from any liabilities.

I Agree

You must select "I agree" in order to submit this application online.

Thank you for your interest in the IHOPE Program! Please be aware that due to demand, slots are limited for all IHOPE approved courses. If you have any questions, please feel free to contact us via email at ihope@bmcc.cuny.edu. www.bmcc.cuny.edu/cuny-in-theheights/ihope/

The IHOPE Program is generously supported by a grant from The Robin Hood Foundation. Our IHOPE Community Partners are WHEDco, NMIC, POTS and BronxWorks.

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