General Information:
First Name *
Last Name *
Middle Name
Date of Birth *
Gender *
Local Address *
Local Address 2
Local City *
Local State *
Local Zip *
Local Phone
Cell Phone Number *
Email *
Social Security Number *

Ethnicity/Race:

 Please select "1" on all that apply to you and leave the rest blank
American Indian/Alaskan Native
Asian
Black or African American
White
Native Hawaiian or Other Pacific Islander
Hispanic/Latino
What language is primarily spoken in your home?
Other Info:
Describe your primary reason for applying *
Are you a US Citizen? *
If no, are you a Permanent Resident?
Resident Alien Number (If Applicable)
Are you a Utah Resident? *
Academic Info:
Current Grade Level *
Current School Attending *
Home many classes are you taking?
Do you plan on taking a College Entrance Exam this year?
If Yes, which one?
Family Information:
Mother/Guardian 1 Educational Level *
Father/Guardian 2 Education Level *
How many people in your household? *
Family Taxable Income Range (Line 11b on 1040) *
Please Upload Parent(s) Most Recent IRS 1040
*Uploaded 1040 is required. Please do not submit application without uploading correct tax document or you will be required to re-submit the application.
Sign and Submit:
Applicant Signature *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number:

Parent/Guardian Signature *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number: