Interest Form

Interested in Rising Scholars?

Please fill out this form if you are interested in joining the Rising Scholars program. Once you submit the form, Jesus or Claudia will get in touch with you to follow up.

What's your first name?*

What's your last name?*

What is your 8-digit De Anza student ID number (also known as a Campuswide ID or CWID number)?

What is your email address?*

What's the best phone number we can use to reach you?

Are you currently or formerly incarcerated?

Yes

Are you currently on probation or parole?

Yes

Do you have close relatives whose lives have been affected by the justice system?

Yes