*Are You:
*First Name:
*Last Name:
*Date of Birth:
Are You a citizen of US: Yes No

**Academic History**
List all undergraduate colleges attended:

*Current Institution:
Previous Institution-1:
Previous Institution-2:

**Eligibility Requirements**
In order to participate in the CLEO College Scholars Sophomore Super Saturdays Seminar, you must be either a low-income, minority, or otherwise disadvantaged student.

I hereby certify that I am:

**Low-income, Economically, or Otherwise Disadvantaged**

 If you are NOT a minority student, you may participate if you are low-income, economically, or otherwise disadvantaged!

*A. Are you low-income ?
*B. Are you economically disadvantaged?
* An individual may be determined to be otherwise disadvantaged if he/she meets at least one of the following criteria
please check all that apply
Attended secondary school in a Title I School District
Participated in a TRIO program
English as a second language
First generation college student
Resided in a public housing facility
Disabled, as defined by the Individuals with Disabilities in Education Act

How did you find out about this seminar?
CLEO Website
Posted Flyer
Facebook / Twitter
Pre-Law Advisor (Name; Institution):
Career Center

This is a one-day Pre-Law program. Accommodations are not being provided. Registration is open on a first come, first serve basis:
DON'T DELAY. This Pre-Law program is open to disabled individuals, as defined by the Americans with Disabilities Act. Please call for any special accommodations that you may require.

* I certify that the above statements are true and correct to the best of my knowledge and belief. I understand that any false or misleading statement may constitute grounds for denial of admission or later expulsion.