EmailMeForm
C Stephen James Candidate for Education Funds
Basic student information so we may direct you to the proper resources.
Student Name
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Prefix
First
Last
Suffix
Student Email
*
Current Status
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Middle School
High School
College Undergraduate
Advanced Degree
Level (i.e. 10th or Sophomore)
*
Student GPA on
4.0 only scale
Zip Code
*
Student Cell Phone
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Sibling names and ages. (i.e. Jenny 16, Dan 12)
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Parent 1 Name
*
First
Last
Parent 1 Email
*
Parent 2 Name
First
Last
Parent 2 Email
Parents Cell Phone
*
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Community Volunteer
Volunteer Email
Field of Study and/or Colleges you are interested in
*
This information is used to conduct the initial interview ONLY