Complete the form and then click "Submit."

I. PERSONAL INFORMATION

First Name: Last Name:
Name as DDC Student (If Name Change):

Date of Birth: Gender:   Male    Female
Ethnicity: Asian   Black   Latino   Native American   White
Other:  

Current Address Street:   Apt#:
City:   State:   Zip:

Home Telephone: Mobile Telephone:
Primary Email Address:

Permanent Address Street:   Apt#:
(if different)City:   State:   Zip:

II. ALUMNI ACTIVITIES

I would be interested in participating in the following activities: (Check all that apply.)
Alumni Committee   Alumni Event Planning   Admissions   Fund Raising
Membership   Mentoring   Newsletter   Speaker/Panelist
Other:  

III. EDUCATION

High School: Graduation Year:

Did you attend a College/University?   Yes    No
College/University: Grad. Year:
Major/Minor: Degree:
Current Year in College: 1    2    3    4    5    6    NA
Currently Attending College/University: Full-Time    Part-Time    NA

If you did not attend or complete College/University, please explain.
Financial Reasons    Family Obligations    Full-Time Employment
Military Branch: Years:

Graduate/Professional School:
Degree: Grad. Year:

IV. DOUBLE DISCOVERY CENTER SERVICES

Please indicate the program(s) in which you participated during your time at DDC:
Early Intervention Initiative (7th/8th grade)    Talent Search    Upward Bound
Other (Please provide name of program):   
Please tell us which years you participated in the program:

Number of Years at DDC: 1    2    3    4    5    6
In what capacity: Student    Tutor/Mentor    Summer Staff    Full-Time Staff

If an alumnus/a of DDC, please check the ways in which DDC was helpful to you:
Academic Classes College Counseling
Personal Counseling Academic Guidance
Financial Aid Information Career Awareness
Seminars/Workshops College Trips
Access to Computers SAT Prep
Exposure to College Campus Summer Program
Motivational Support BOND/YWA
Interaction with Columbia Students Interaction with Columbia faculty
Other:

Review your form and then click "Submit."