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Our Programs

Programs Student Application

Pre-Screening Questionnaire


In order to determine your eligibility to become a scholar in Operation Jump Start, please complete all sections below. If you have any questions, please contact us!

All applicants must present the following on the day of their student interview:

  • Copy of U.S. residency or citizenship (Birth Certificate)
  • Copy of most current report card
STUDENT INFORMATION
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Gender:
Residence Status:
Sibling Previously in Program:
Are you currently participating in any of these pre-college programs? (Check all that apply)

PARENT/GUARDIAN INFORMATION
Parent/Guardian 1:
Highest level of education completed:
Parent/Guardian 2:
Highest level of education completed:
INCOME INFORMATION
Is your family receiving public assistance:
Taxable income range (See line 43 on Form 1040, line 27 on 1040 A, line 6 on 1040 EZ)

By submitting this form, I certify that the information provided on this pre-screening questionnaire is true to the best of my knowledge and that any misrepresentation may be cause for denial or cancellation of admission.

Our Impact This Year

  • Students Served

    410

  • One-on-One Mentoring Hours

    1500

  • Scholarships Awarded

    $50000

  • College Attendance Rate

    98%

© 2017 Operation Jump Start

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