Applicant Information

IMPORTANT APPLICATION INFORMATION:
You must have your own separate email address in order to apply to Step-Up. That means if you want to apply, you cannot use an email address that you share with someone else. We encourage you to use your school email address or open a free email account at www.gmail.com. Write down the password to your email address and check your inbox at least once a week. Step-Up will communicate with you by email.

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* 1. First Name

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* 2. Middle Name

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* 3. Last Name

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* 4. Contact Information

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* 5. Your Date of Birth (use format: xx/xx/xxxx, i.e. 01/15/2001)

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* 6. Parent or Guardian Email Address

Emergency Contact Information

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* 7. Emergency Contact Name:

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* 8. Relationship to You:

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* 9. Phone Number:

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* 10. On what phone number do you want to receive voice message and/or phone calls from Step-Up staff? (format: (402) 101-1001)

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* 15. What is your primary language spoken?

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