MINORITY ACCESS TO HIGHER EDUCATION

PROJECT M.A.T.H.E.

COLUMBIA, SC 29204

STUDENT PARTICIPANT APPLICATION FORM

Through the use of a telecommunications network, Benedict College will develop an interactive program for students, parents, and other members of the community. The project will implement two program activities: (1) an After School Tutorial Program and (2) Saturday workshops for both parents and students. Some of the specific objectives of the project are to: (1) strengthen academic skills for middle and secondary students; (2) provide a forum for students to explore math based careers; (3) encourage parental and community involvement in education, culture, and lifelong learning; and (4) expose students, parents, and others in the community to the Internet and other electronic communications systems.

This project will improve standardized test scores and overall academic performance among students and increase the use of telecommunications technology by students, parents, and community through the use of technology. The success of this project will serve as a model to establish future partnerships between Benedict College and other communities in South Carolina.

First Time Applicant?

Yes No

 Personal Information

First and Middle Names

Last Name

Street Address

City

State/

Province

Zip/Postal Code

Country

Phone

E-mail

Health Status

Excellent Good Fair Poor

Do you require any special attention? Yes No

If so, explain

In case of an emergency, Contact

Phone Number

Family Background

Father Living Yes No

Occupation

Mother Living Yes No

Occupation

Number of members in household?

School you currently attend

Grade level

How do you identify yourself?

Black/African American Caucasian Hispanic/Spanish Native American

Other (Specify)

What is your age range? 12 - 13 14 - 15 16 - 18

Contact: Dr. Larry L. Lowe at (803) 253-5007 (O); 540-2523 (FAX); E-Mail: llowe@crle.com

MSC 36
Benedict College
1600 Harden Street
Columbia, SC 29204