Life Prep Application Page

The Girl Talk Life Prep Academy Application

Name(Required)

First Last

Age(Required)

I am a rising...

Freshman

Sophomore

Junior

Senior

*Select One

Date of Birth(Required)

School(Required)

Race/Ethnicity(Required)

Annual Household Income(Required)

Household Size(Required)

Referred by:

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Email(Required)

Does your family receive any type of governmental assistance (i.e., food stamps, housing assistance, etc.)?(Required)

Yes

If Yes, please list any types of assistance.

Do you have health insurance?(Required)

Yes

If Yes, please specify provider's name.

i.e., BlueCross Blue Shield, TennCare, Humana, etc.

Parent/Guardian Name(Required)

First Last

Relationship to Applicant(Required)

Parent/Guardian Phone(Required)

Parent/Guardian Email(Required)

Letter of Recommendation(Required)

Max. file size: 300 MB.

Please upload your letter of recommendation for the Girl Talk Life Prep Academy.

Proof of minimum 2.5 GPA(Required)

Max. file size: 300 MB.

ie. Final Report Card *Rising Freshmen ONLY, High School Transcript *Rising Sophomores, Juniors, and Seniors ONLY

Personal Statement (1-2 page essay)(Required)

Max. file size: 300 MB.

Topic: Briefly state your educational and career goals, and explain how they align with the objectives of the Life Prep Academy.

I have completed the above application and attached the required documents.(Required)

I agree.