2024 UtmostU Enrollment Form
Tell us who you are.
First Name
M.I.
N/A if none
Last Name
Suffix
Birthdate
Gender
Please select...
Male
Female
Non-Binary
Transgender
Gender Non-Conforming
Other
Race
Please select...
Black or African American
White
Asian
Native American or Alaska Native
Pacific Islander
Multicultural
Unknown
Other
Ethnicity
Please select...
Hispanic
Non-Hispanic
Unknown
Name of Organization that is supporting you
Please select...
5 Strong Scholars
After School Matters - Lutz Scholars
Bridges Scholar - City Colleges of Chicago
By The Hand
Catalyst Maria High School
CHAMPS
Chicago Collegiate Charter School
Comer Education Campus
Delta Health Alliance
Genesys Works
Green Halo
Horizons for Youth
Intrinsic Schools
Legal Prep Charter Academy
LINK Unlimited
Loyola Academy
North Chicago Community High School
Seneca Foundation
UChicago Charter School
Waukegan to College
Youth Guidance
Contact Information
Personal Email
Which email do you check most often?
x
Secondary or School Email
Phone
Are you interested our free T-Mobile cell plan?
Yes
No
We can hook you up with a free T-Mobile data line to help save you thousands of $$ during your time as an UtmostU fellow.
x
Who is your primary family contact person?
This can be a parent, guardian, or other family member who very closely supports you on your college or career journey.
Family Contact Name
Family Contact Phone Number
Family Contact Email
Family Contact Relationship to You
Where do you call home?
Address Line 1
Address Line 2
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip/Postal Code
Do you live in the City of Chicago?
Please select...
Yes
No
Which Chicago Community Area do you consider home?
High School Information
Name of High School Attended
HS Grad Year
Please select...
2016
2017
2018
2019
2020
2021
2022
2023
2024
Final HS GPA
Highest ACT Score
Highest SAT Score
Do you identify as having a disability?
Please select...
Yes
No
I'm not sure
Prefer not to answer
You are considered to have a disability if you have a physical or mental impairment or medical condition that limits a major life activity. Examples can include ADHD, Autism, Blindness, Deafness, Cancer, Crohn's Disease, Diabetes, Dyslexia, and Cerebral Palsy, Wheelchair use, and more.
x
What language do you speak at home most regularly?
Please select...
English
Spanish
Arabic
Tagalog
Chinese
Polish
Other
Other, please explain
Now, tell us your goals.
What are your plans for after high school?
Please select...
Attend a College or University
Military enlistment
Enter the Workforce
Professional credential or training program
Entering the Workforce
Do you already have a job lined up?
Please select...
Yes, full-time
Yes, part-time
I'm pretty sure
Not yet
Have you started applying for jobs yet?
Please select...
Yes, full-time
Yes, part-time
I'm pretty sure
Not yet
Name of Employer
Position
Start Date
City Employer is Located
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
What forms of job search have you been using?
Online Job Listings (Indeed, LinkedIn, etc.)
Networking
Career Fairs
Referral
Other
What career pathway(s) are you interested in?
Business
IT
Medical
Mechanical
Other
Selec all that apply.
Military Enlistment
Which branch of the military will you be joining?
Please select...
Air Force
Army
Coast Guard
Marine Corps
National Guard
Navy
Have you taken your Oath of Enlistment?
Please select...
Yes
Not yet
Have you already completed Basic Training?
Please select...
Air Force
Army
Coast Guard
Marine Corps
National Guard
Navy
Enlistment Date
Career Field/MOS
N/A if none
Post-Secondary Institution Information
Name of Intended or Current Post-Secondary Institution
If you are still in high school, where do you plan to go to college? If you have already graduated, where are you currently enrolled or where do you plan to enroll?
x
Post-Secondary Institution Type
Please select...
2-year
4-year private
4-year public
Academic Area You Plan to Study
Please select...
Accounting, Economics & Finance
Agriculture & Natural Resources Conservation
Architecture
Area, Ethnic, & Multidisciplinary Studies
Biological & Physical Sciences
Business Management & Administration
Communications
Computer Science & Mathematics
Education
Engineering & Engineering Technology
English & Foreign Languages
General Studies
Health Administration & Assisting
Health Sciences & Technologies
Hospitality & Tourism
Human Services
Marketing & Sales
Mathematics
Philosophy, Religion, & Theology
Repair, Production, & Construction
Social Sciences, History & Law
Transportation, Distribution And Logistics
Undeclared
Visual & Performing Arts
Choose the closest match
x
Where do you plan to live while taking classes?
Please select...
On campus dorms or apartments
Off campus house or apartment
Commuting from home
Just taking Online Courses
Are you a First Generation College student?
Please select...
Yes
No
Being a first-generation student means that your parent(s) did not complete a 2- or 4-year college or university degree, regardless of other family member's level of education. You can have older siblings who are enrolled or completed college and still be considered a first-generation student.
x
Professional credential or training program
Name of School or Program Providing Training
Credential or Training Program Name
Academic Area You Plan to Study
Please select...
Accounting, Economics & Finance
Agriculture & Natural Resources Conservation
Architecture
Area, Ethnic, & Multidisciplinary Studies
Biological & Physical Sciences
Business Management & Administration
Communications
Computer Science & Mathematics
Education
Engineering & Engineering Technology
English & Foreign Languages
General Studies
Health Administration & Assisting
Health Sciences & Technologies
Hospitality & Tourism
Human Services
Marketing & Sales
Mathematics
Philosophy, Religion, & Theology
Repair, Production, & Construction
Social Sciences, History & Law
Transportation, Distribution And Logistics
Undeclared
Visual & Performing Arts
Choose the closest match
x
Start Date
City Program is Located
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Do you have regular access to a computer?
Please select...
Yes, I own a computer
Yes, borrowing
Yes, at library or other public source
No
What do you hope to achieve during your time as an UtmostU Fellow?
List up to five topics that your coach can help you with as you work toward your goals.
Enrollment Survey
The following questions were created with your success in mind. By answering these questions honestly, you'll be providing your coach with some great insight into how you are doing and where they can step in to support U.
How true are the following statements about your High School experience?
I have felt a sense of belonging at my high school.
Please select...
Strongly Disagree
Disagree
Agree
Strongly Agree
I have felt like a member of my high school community.
Please select...
Strongly Disagree
Disagree
Agree
Strongly Agree
I am glad I have attended this high school.
Please select...
Strongly Disagree
Disagree
Agree
Strongly Agree
My high school has been supportive of me.
Please select...
Strongly Disagree
Disagree
Agree
Strongly Agree
How often do you do the following tasks?
Make a list of the things you have to do each day.
Please select...
Never
Occassionally
Often
Always
Plan your day before you start it.
Please select...
Never
Occassionally
Often
Always
Have a clear idea of what you want to accomplish during the next week.
Please select...
Never
Occassionally
Often
Always
How true are the following statements?
I work hard to be successful.
Please select...
Strongly Disagree
Disagree
Agree
Strongly Agree
I do not worry about belonging in my college, job, or program.
Please select...
Strongly Disagree
Disagree
Agree
Strongly Agree
I am able to handle most upsetting problems.
Please select...
Strongly Disagree
Disagree
Agree
Strongly Agree
If I run into difficulties in life, I work harder to overcome them.
Please select...
Strongly Disagree
Disagree
Agree
Strongly Agree
How confident are you that you could complete the following tasks?
Research a term paper
Please select...
Very Confident
Confident
Somewhat Confident
Not at all Confident
Do well on your exams
Please select...
Very Confident
Confident
Somewhat Confident
Not at all Confident
Take good class notes
Please select...
Very Confident
Confident
Somewhat Confident
Not at all Confident
Keep up with your school work
Please select...
Very Confident
Confident
Somewhat Confident
Not at all Confident
Keep up with assigned tasks at work
Please select...
Very Confident
Confident
Somewhat Confident
Not at all Confident
Manage time effectively
Please select...
Very Confident
Confident
Somewhat Confident
Not at all Confident
Create a polished resume
Please select...
Very Confident
Confident
Somewhat Confident
Not at all Confident
Successfully complete an interview
Please select...
Very Confident
Confident
Somewhat Confident
Not at all Confident
To what extent do you agree with the following statements?
I am prepared for the academic requirements of college.
Please select...
Strongly Agree
Agree
Disagree
Strongly Disagree
I have what it takes to be successful in my classes in college.
Please select...
Strongly Agree
Agree
Disagree
Strongly Disagree
I would feel like a failure if I needed help in school.
Please select...
Strongly Agree
Agree
Disagree
Strongly Disagree
If I didn't understand something in class, I would guess rather than ask someone for assistance.
Please select...
Strongly Agree
Agree
Disagree
Strongly Disagree
You can learn new things, but you can't really change your basic intelligence.
Please select...
Strongly Agree
Agree
Disagree
Strongly Disagree
A college degree is necessary for me to reach my career goals.
Please select...
Yes
No
I'm not sure yet
My family life often conflicts with my school class schedule.
Please select...
Strongly Agree
Agree
Disagree
Strongly Disagree
The amount of time my family takes up makes it difficult to fulfill student responsibilities.
Please select...
Strongly Agree
Agree
Disagree
Strongly Disagree
Finally, let's talk about money
Does your family have enough money for daily living expenses each month?
Please select...
Yes
Not sure
No
Will you be helping with your family's living expenses each month?
Please select...
Yes
Not sure
No
Do you plan to work while enrolled in school or training program?
Please select...
Yes, full-time
Yes, part-time
Not sure
No
Check off all of the items you are concerned about affording.
Textbooks and Materials
Tuition and Fees
Daily Living Expenses
Transportation
Uniform or Scrubs
Medical care
Mental health care
We use Zelle to send most payments to Fellows.
Do you have a bank account?
Yes
No, I don't want to receive payments from UtmostU
No, but I'd like to get one
Do you need help setting up a bank account?
Yes
No thanks
Have you accepted payment through Zelle before?
Yes
No
Not sure
What is the name of your bank?
Phone # Connected to Bank
Email Connected to Bank
If you do not fulfill your responsibilities as part of this agreement
, UtmostU has the right to remove you from the program. We certainly do not want to do this, but we need to make this clear.
I will do my best to regularly review UtmostU communications so that I can stay up-to-date on available and upcoming opportunities.
Please select...
I agree
UtmostU can hook you up with loads of resources that help get you on the path to success ranging from internships, summer classes, and scholarships to help keep you going. We regularly send out emails and texts, as well as social media posts that will keep you up-to-date!
x
I will connect with my coach if I am considering transferring or withdrawing from my post-secondary or certificate program.
Please select...
I agree
We understand life happens and your interests may change! Knowing this information will help us support you.
x
I will provide my coach with relevant information regarding my academic and career journey when requested.
Please select...
I agree
This can include unofficial transcripts, FAFSA and Financial Aid information, class schedules, etc.
x
If I enroll in a college or university, I will provide my coach and UtmostU with an unofficial transcript twice per year to confirm my academic progress.
Please select...
I agree
This may be over a phone or video call, texts, social media, or in-person meeting.
x
I will respond to my assigned coach in a timely manner when they reach out to me.
Please select...
I agree
This may be over a phone or video call, texts, social media, or in-person meeting.
x
Please read the below statement and let us know we're on the same page.
Your privacy is important to us.
I agree that UtmostU may share my personal information with its supporting staff and its affiliates to assist UtmostU and its affiliates in administering the program. I am aware that the personal information that UtmostU may share may identify me and may include details such as name, address, phone number, email address, birthdate, ethnicity, gender, and certain financial information.
I agree.
Contact Information