First Name *

Last Name *

Date of Birth *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Phone Number: *

Personal Email: *

Personal Email: (Confirmation) *

City: *

Street Address: *

State: *

Zip: *

Student Type: *
- Select Option High School Student Adult Learner

Current Grade Level" *
- Select Option 9th Grade (Freshman) 10th Grade (Sophomore 11th Grade (Junior) 12th Grade (Senior)

Current Education Status: *
High School Graduate - No College Experience
Some College - No Degree
Associate Degree Holder
GED or Alternative Diploma
Currently Enrolled in Community College or Certificate Program
Returning to College After Time Away
Veteran or Active Military

Most Recent School/Organization *

Current or Last K-12 District Attended: *

Please check all that apply: *
I am a legacy student (related to a current or former Pathways student)
I am newly enrolled at a current Pathways to GVSU partner school/organization
I do not fall into either category, but I am still interested in joining the program

Note: Students who select the third option may still be considered on a case-by-case basis. A member of our team will follow up with additional questions if needed.

Select your current Pathways to GVSU Partner *
- Select Option Battle Creek STEM Innovation Center Detroit Achievement Academy Detroit Edison Public School Academy Detroit PAL Detroit Prep LAUP New Level Sports Ministries Timberland Charter Academy University Prep Academy Middle School University Prep Art & Design Middle School University Prep Science & Math Middle School

Name of Pathways student: *

Relationship to Applicant: *
- Select Option Sibling Cousin Niece/Nephew Other

Parent/Guardian (Full Name): *

Phone Number: *

Parent/Guardian Email: *

Parent/Guardian Email: (Confirmation) *

In a few sentences, tell us why you would like to join the Pathways to GVSU program. *

Your First Name *

Your Last Name *