Think First. Type Second. This worksheet allows you to read and complete questions before entering your information online. This is a good time for you to check with your school counselor or college advisor regarding any question or answer of which you may be unsure.
Middle Name: _________________________________________________________________
Last Name: _________________________________________________________________
Suffix (i.e. Jr., III): _________________________________________________________________
Permanent Home Mailing Address: _________________________________________________________________
ADDRESS LINE 1 _________________________________________________________________
ADDRESS LINE 2 ______________________________ ____________________ ___________
CITY STATE/TERRITORY ZIP (U.S. ONLY) _________________________________________________________________
Social Security Number: _________________________________________________________________
Date of Birth: _________________________________________________________________
Gender: ● Male ● Female If you would like the opportunity, we invite you to share more about your gender identity: _________________________________________________________________
Home Phone Number: _______________ Mobile Phone Number: _______________
Would you like to receive important text messages? ● Yes ● No Profile Tab:
Profile Snap Shot
MM/YYYY All applicants, please indicate your race ● American Indian or Alaskan Native ● Asian ● (select one or more): ● Native Hawaiian or Other Pacific Islander ● Hispanic ● African American ● White
Is English your native language? ● Yes ● No Have you been dismissed, expelled and/or suspended from a college for disciplinary reasons? If yes, give the approximate date(s) of each incident, explain the circumstances and reflect on what you have learned from the experience.
You may use up to 400 words. Profile Tab: Citizenship Section Are you a U.S. Citizen? ● Yes ● No Country of Birth: _______________________________________________________________
Country of Citizenship: _______________________________________________________________ Are you a permanent resident of the U.S ● Yes ● No If yes, please provide your alien registration number:
PROVINCE (OUTSIDE U.S.) POSTAL CODE (OUTSIDE U.S.) COUNTRY (OUTSIDE U.S.) Profile Tab: Demographics Section Military/Veteran Status: ● Active Duty Military ● Dependent of Veteran ● Veteran ● National Guard or Active Reserve Are you Hispanic/Latino? ● Yes ● No If Hispanic/Latino, is your background: ● Central American ● Cuban ● Dominican ● Mexican ● Puerto Rican ● South American ● Other Does one or more of the following apply to you: you are or were in foster care at any time after the age of thirteen; you are an orphan who was not adopted before the age of thirteen?
MM/YYYY What college credits have you received or do you ● Advanced Placement (AP) ● College Level Examination Program (CLEP) expect to receive before you graduate?
High School Name and Address: _________________________________________________________________
COLLEGE NAME _________________________________________________________________
COLLEGE ADDRESS ________________________________ / ______________________________
DATE ENTERED (MM/YYYY) DATE LEFT (MM/YYYY) _________________________________________________________________
GPA First Campus: ● Fall 20______ ● Spring 20______ ● Summer 20______ ___
Submit the following for a completed application:
- Official Community College transcript(s)
- SAT or ACT scores (College Board School Code: 0755, ACT Code: 2953)
- One letter of recommendation (or form allowing for individual comments) from a Community College counselor or teacher.
- Note: All applicants in addition to the above items, must submit a brief, personally written statement of purpose that addresses the reasons s/he wishes to enter the H.A.A.T. program. Please limit your response to 500 words or no more than 1.5 type-written pages. Submit essay via email as an attachment to email@example.com
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Submit the following for a completed application:
Letter of recommendation from 3 adult supporters not related to you.
- Request an official transcript from every college or educational institution you’ve attended since high school and mail to the Admissions office. Faxed transcripts aren’t considered official. Transcripts should be mailed to
- Office of Dakar Foundation
17838 Erwin Street,
- Encino, Ca 91316
- If you’ve earned fewer than 30 college credits after high school graduation at the time of application, your high school transcript and standardized test scores are required. You should request your official transcript from your high school to be submitted electronically or by mail to Dakar Foundation (address above). Have your SAT/ACT scores sent electronically from the testing service. The College Board SAT Code: 0755, ACT Code: 2953
Questions? Call 818- 481 1083 or email firstname.lastname@example.org