LEGACIE Application Latinos Empowered Guided And Cultivated In Education (LEGACIE)2021 - 2022 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 8, 2021 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?*YesNo2. 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)* 2019 LEGACIE Scholar First Generation College Student CalWORKS/CARE DSPS (Students with disabilities) EOP&S Guardian Scholar Homeless/Housing Insecure LGBTQIA Parent Re-entry Student (25 years or older) RISE Scholar (Formerly Incarcerated or System Impacted)) Undocumented/DREAMER Veteran Head of Household None of the Above 9. How many units are you taking during the Fall 2021 semester at Rio Hondo College?*10. How many college units have you completed at Rio Hondo College?*11. What is your overall GPA? (Please indicate if you do not have a GPA yet)*12. How many years do you plan to be at Rio Hondo College?*12345678 or more13. Will you be attending another college during Fall 2021 in addition to attending Rio Hondo College?*YesNo13a. What other colleges will you be attending?* 14. Do you work?*YesNo15. 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. Can you participate in the following mandatory LEGACIE activities on the following dates and times? Fall semester activities will be held via Zoom.*YesNoWednesday, September 30, 2021 from 4:30pm to 6pm (on Zoom)Wednesday, November 17, 2021 from 4:30pm to 6pm (on Zoom)Wednesday, February 16, 2022 from 4:30pm to 6pm (location TBD)Wednesday, April 20, 2022 from 4:30pm to 6pm (location TBD)Wednesday, May 4, 2022 from 4:30pm to 6pm 18. What are your career aspirations? (Answer in one sentence)*19. What is your expected completion date and/or transfer date?* Date Format: MM slash DD slash YYYY 20. Please explain how this mentorship program can help you reach your goals?*21. 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.)*22. Do we have your permission to share your responses with your mentor?*YesNoSignature*Date* MM DD YYYY EmailThis field is for validation purposes and should be left unchanged.
