LEGACIE Application Latinos Empowered Guided And Cultivated In Education (LEGACIE)2022 - 2023 Application Step 1 of 4 0% Please complete and submit the following application to be considered for the Latinos Empowered Guided and Cultivated in Education (LEGACIE) Program by Wednesday September 7, 2022 by 11:45 p.m. Remember to provide a phone number and email that you use regularly, we will contact you with the information you share with us should you be accepted into the program. Keep in mind there are two short answer questions to complete at the end of this application. Please only submit the application once you have answered all questions. Assistance in organizing/writing short answer responses is available at the Writer's Resource Center (LR 117). Contact Juan Mendez at jumendez@riohondo.edu or at (626) 502-7031.1. Do you identify as a Hispanic/Latinx Male?* Yes No 2. Student ID (IE: 001234567)* 3. Student Name* First Middle Last 4. Home Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 5. Preferred Phone Number*6. Preferred Email* 7. What is your current major?* 8. Do you self-identify with any of the following categories/groups? (MARK ALL THAT APPLY)* Adult Re-Entry (25 years of age or older) First Generation College Student (first in your immediate family to attend college) CalWORKS/CARE DSPS (Students with disabilities) EOP&S Guardian Scholars (experience with foster care system) HOPE Scholar (experiencing homelessness/housing insecurity) Queer Initiative (LGBTQIA+) Parent RISE Scholar (Formerly Incarcerated) Undocumented/DREAMER Veteran Head of Household None of the Above 9. How many units are you taking during the Fall 2022 semester at Rio Hondo College?* 10. How many college units have you completed at Rio Hondo College?* 11. What is your expected completion date and/or transfer date? MM slash DD slash YYYY 12. What is your overall GPA? (Please indicate if you do not have a GPA yet)* 13. How many years do you plan to be at Rio Hondo College?*12345678 or more14. Will you be attending another college during Fall 2022 in addition to attending Rio Hondo College?* Yes No 14a. What other colleges will you be attending?* 15. Do you work?* Yes No 15a. On average how many hours do you work per week?* 16. Please mark all of your personal interests? (This answer will help us pair you with your mentor)* Entrepreneurship Faith Fashion Health/Fitness Hiking/Running Learning Listening to Music Musical Instrument Reading Social Justice/Advocacy Sports Video Games Volunteering Other (please specify) Other personal Interest:* 17. Please answer "YES" or "NO" if you can participate in the following mandatory LEGACIE activities on the following dates and times. (Hybrid format for now)*YesNoWednesday, September 21, 2022 from 4:30pm to 6pm*Wednesday, November 16, 2022 from 4:30pm to 6pmWednesday, February 15, 2023 from 4:30pm to 6pmWednesday, April 19, 2023 from 4:30pm to 6pm**In person for now; may resort to Zoom if county public health guidelines change 18. What are your career aspirations? (Answer in one sentence)* 19. Please explain how you hope this mentorship program can help you reach your goals?*20. Please explain if there are any issues/barriers that prevent you from completing your educational goals at Rio Hondo College (for example, caring for sick relative, supporting the family, caring for younger siblings, living with a temporary or permanent disability, translating for family members, using public transportation for long distances, etc.)*21. Do we have your permission to share your responses with your mentor?* Yes No 22. Is there anything else that you would like to share with the committee?Signature*Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
