Interest Form for 2024 Peralta Colleges Summer Institute

For information and fliers for all the career exploration summer courses or workshops, please see: https://www.peralta.edu/dual-enrollment/summer-institute

For a quick list of summer opportunities: https://app.grouptrail.com/public/sites/22258

ATTENTION GRADUATING SENIORS: Only Workshops are FREE after you graduate. Work with your school counselor to apply for Financial Aid if you want to take a credit-bearing course this summer. For OUSD graduating seniors, please talk to your school counselor about how OUSD will support tuition payments for Summer 2024.

COMPLETION OF THE INTEREST FORM DOES NOT GUARANTEE ENROLLMENT IN THE SUMMER INSTITUTE.

Directions: Complete this form. You will be contacted by your high school Peralta Institute Coordinator soon for next steps. Watch for a text message or email.

Please contact your high school counselor, work-based learning specialist, or college & career coordinator with questions.

By sharing your cell phone number below, you are giving us permission to text you about this program.

Please note that the information shared on this form will be shared with Peralta Community College District, area district and school lead staff, and contracted staff supporting with Peralta Institute. Information will not be shared for any reason beyond what is explicitly needed for participation in the Peralta Summer Institute.

First Name *

Student Middle Name

Student Last Name *

Date of Birth

Student Cell Phone Number *

Student's School email address *

Student's School email address (confirm)

Student's Personal Email *

Student's Personal Email (confirm)

Student Address: House # and Street *

Student Address: City *

Student Address: State *

Student Address: Zip Code *

High School *

If you selected "Other School" please write the name of your school here.

School District *

Other School District

Current Grade *

Ethnicity (Select all that Apply) *

Gender Identity:Your innermost concept of self as male, female, a blend of both or neither – how you perceive yourself and what you call yourself. Your gender identity can be the same or different from your sex assigned at birth. *

In your high school, are you in a Career Pathway? If so select the industry sector that your career courses are in:

Which career exploration college course or workshop would you like to enroll in this summer (First choice)?

Course = grade goes on high school and college transcripts

Workshop = grade does NOT go on college transcript

Select from this dropdown *

If your 1st choice is not available, please select a 2nd option.

Course = grade goes on high school and college transcripts

Workshop = grade does NOT go on high school or college transcripts

Select from this dropdown *

If your 2nd choice is not available, please select a 3rd option.

Course = grade goes on high school and college transcripts

Workshop = grade does NOT go on high school or college transcripts

Select from this dropdown *

Do you have any disabilities or learning differences that you would like support with? *

If you have any disabilities or learning differences that you would like support with, please let us know here:

Who is the person at your school coordinating your involvement in the Peralta Summer Institute?

If you choose "other" under "Who is helping you complete this form?" please write their name here.

What is their email address? *

Parent or Guardian Name *

Parent or Guardian email address *

Parent or Guardian Cell Phone Number *

Parent or Guardian Name (2)

Parent or Guardian email address (2)

Parent or Guardian Cell Phone Number (2)

If you have taken any Career-focused courses at your high school, please list the ones you have taken. If you are in a Career Pathway, please provide the name of the pathway. (Leave blank if none have been taken)

If you have taken any other Peralta Community College courses below, please select which college you were enrolled?

If you answered YES to the question above, please type your Peralta Student ID number here:

Have you partcicpated in Peralta Summer Institute before? If yes, please select what year. (select all that apply)

If you have taken a community college course below, please type the name of the class that you were enrolled in:

OUSD Student ID Number *

OUSD has secured funding to provide financial support in the way of stipends for qualified students that may otherwise not be able to participate in the Summer Institute for economic reasons. Please rate your level of need for a stipend in order to participate in the Summer Institute.