Growing Opportunities in Technology
and Engineering Careers (GO TEC)
Student Information Form
Contact Information:
Name:
Mailing Address:
City: State: ZIP:
E-mail Address:
Phone Number:
Demographic Information:
Gender: Female Male
Ethnicity: Hispanic or Latino Not Hispanic or Latino
Race: American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacic Islander
White
Citizenship: U.S. Citizen
Permanent Resident
Other
Academic Information:
Which IHCC program are you planning to complete?
High school GPA: or GED test score:
If you are currently an IHCC student, enter your cumulative GPA here:
Armation:
I understand that the information I provide on this page will be used to determine my
eligibility for a GO TEC scholarship. I also understand that I may lose eligibility if I provide
incomplete or incorrect information.
Signature:
Date:
Questions? E-mail Kimberly.Dreaden@indianhills.edu or call (641)969-4167
GO TEC is funded by the National Science Foundation under Grant Number 1458301.
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