Statement of Confidentiality: The information submitted in this form is to determine the applicant’s eligibility for CU-ASPIRE Fresh Start Program. Information received is confidential.
Open to all 55 WV counties. Applications will be accepted until all slots are filled. Registration due date is June 28th. ONLY 15 SLOTS AVAILABLE.
Ethnic Heritage (Please check all that you identify with.)
Financial information
Natural or Adoptive Mother’s Name:
Natural or Adoptive Father’s Name:
Legal Guardian's Name (if you don't reside/live with a parent):
Concord University will NOT provide transportation to and from the campus for the participants. Please contact your CRP or DRS counselor in regard to transportation from home to the campus and from campus to home.