Crafton Hills College
Science Technology Engineering and Mathematics (STEM) Academy/Trek
Application
Please email application to Patricia Menchaca at pmenchaca@craftonhills.edu. You may also
schedule an appointment to deliver your application in person by calling 909 389-3575.
Applicant Information
Last Name: First: MI:
Date of Birth Student ID #
Street Address: Apt/Unit #:
City: State: Zip:
Email: Contact Phone:
Education (All applicants must complete the section)
What is your educational goal? What is your Major:
Transfer Without
AA/AS Degree
Transfer With
AA/AS Degree
Vocational AA/AS
Degree
Certificate/License
Other ___________________________________
What school(s) are you interested in transferring to:
Check all that apply:
I have taken the Crafton Hills College assessment test or a math course at another college. YES NO Course: _________________________
What Math course are you currently enrolled in? (If you are not enrolled in a Math course which is the last Math course you successfully completed at
Crafton?)
Math 090
Math 095 Math 102 Math 103 Math 160 Math 250, 251, or 252 Math 265 or 266
Have you completed less than 44.9 units at Crafton Hills College? YES NO
Are you a member of any of the following programs (If so, please check the appropriate box) :
EOP&S, DSP&S, CalWorks Military/Veterans? Not a member of any
Do you have a degree?: NO If yes, select all that apply: BA./B.S A.A. (T) /A.S. (T) Other ___________________
Do you have external transcripts? YES NO
*List colleges other than Crafton Hills College
Are your external transcripts on file at Crafton Hills College?
YES
NO
College Dates Attended
College Dated Attended
Disclaimer and Signature
I certify that I am aware that first priority for the STEM Trek program is given to full-time students with fewer than 44.9 overall college units. I
understand that my application must be signed and dated. I acknowledge all of the information on this application in true and correct.
Signature: Date: Date Stamp
