Application & Questionnaire
Personal Identification
1. Full Legal Name______Gender: Male/Female
2. Date of Birth: ______
3. Address: ______
______
4. Telephone Number: ______Email Address: ______
5. Are you presently: enrolled in Ifetayo’s Rites of Passage or a graduate of Ifetayo’s Rites of Passage?
Dates of Attendance ______Year of Graduation: ______
6. Do you have an IDA account in good standing? YES NO
7. How many years have you been at Ifetayo?______
8. What programs have you or do you participated in? ______
Family Information
9. Primary Parent's or Guardian's Name: ______
Relationship: ______
Occupation: ______
10. Address: ______
______
Telephone Number: ______
11. Number of Siblings: ______
Siblings Name: ______Age: ______Gender:Male/Female
Siblings Name: ______Age: ______Gender: Male/Female
Siblings Name: ______Age: ______Gender: Male/Female
Siblings Name: ______Age: ______Gender: Male/Female
Siblings Name: ______Age: ______Gender: Male/Female
12. Have your parents or any siblings obtained a college degree? Yes or No
If yes, please specify: ______
______
______
Education
13. High School Name: ______Graduation Date: ______
14. College education to date
Total number of credits earned: ______
College presently enrolled in (name):______Major: ______
Dates Attended: ______Full-Time or Part -Time
Current Grade Point Average: ______
Other Colleges attended
Name of College: ______
Dates attended: ______Full-Time or Part-Time
Total number of credits earned: ______
Grade Point Average for last semester attended: ______
Name of College: ______
Dates attended: ______Full-Time or Part-Time
Total number of credits earned: ______
Grade Point Average for last semester attended: ______
15. Did you receive tuition support from the college during your last semester? YES NO
If yes, how much?______
16. Do you anticipate receiving aid next semester? YES NO
If yes, how much? ______
17. For what purpose(s) would you use an EGC scholarship this semester?
(Check all that apply)
Tuition
Books
Supplies
Computer
Transportation
Other (specify)______
18. In what extra-curricular or community activities have you or do you participate?
______
______
______
______
Employment
19. Do you plan to be employed while attending college? YES NO Full-Time or Part-Time
20. If yes, in what capacity? ______
______
“For tomorrow belongs to the people who prepare for it today”
– Yoruba Proverb
Thank you for Joining the Spirit of Living Culture and Building Community at Ifetayo!
1Ifetayo Cultural Arts Academy, Inc. | 629 East 35th Street Brooklyn, New York 11203 | p: 718-856-1123 f: 718-856-1192 e: