LIFE Application | NorthWest Arkansas Community College

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LIFE Application

5 digit zip code
Ethnicity (select all that apply)
Parent/Guardian Information/Emergency Contact
Program Details
Please indicate your shirt size (We can not guarantee that shirts will be provided this year)
Do you require assistance or accommodation due to a disability
If yes, please indicate
Education Information

Name of high school
Current Grade
SENIORS ONLY: Please check all of the following that apply to you regarding your plans for after graduation
SENIORS ONLY: Would you be willing to connect with LIFE Staff and Mentors through one or more of the following ways: email, cell phone, social media, Zoom, etc.
Do you participate in any of the following programs (check all that apply)
About You
How did you hear about the LIFE Program? (select all that apply)
How can the LIFE program best communicate virtually with you at this time?