Kanawha Valley FAME Program Application

IN THIS SECTION

Please don't fill out this input box.

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Email*

Home Phone*

Mobile Phone

Birthdate*

Are You a U.S. Citizen or Permanent Resident?*

Please List Colleges Attended

High School*What high school did you attend?

High School GPA*

Grade Received in Algebra 1*

Grade Received in Algebra 2*

Grade Received in Pre Calculus*

Grade Received in Calculus*

Grade Received in Trigonometry*

College Entrance Exam Mathematics Score*

College Entrance Exam English Score*

College Entrance Exam Reading Score*

Please List All STEM-Related Extracurricular Activities You Have Been Involved In, Including PLTW, Skills USA, or Another STEM-Related Program. Share Also Any Regional, State, or National Level Competitions.

Please List Any Awards

Please List Any High School Activities

Please List Any Technical Skills Including Any Pre/Post Secondary Classes You May Have. Please Designate Type, Length to Complete. Include Dates, Grade, and Any Certificates or Degrees Earned.

Please List All Previous Work Experience. Designate Full or Part Time Along with Dates Employed

Racial Identity (Optional)

Ethniticity (Optional

Gender (Optional)

How Did You Hear About the AMT Program?*

Please Select Your First Choice for the Manufacturing Business Partner You Wish to Work With*

Please Select Your Second Choice for the Manufacturing Business Partner You Wish to Work With*

Please Select Your Third Choice for the Manufacturing Business Partner You Wish to Work With*

Nondiscrimination Statement

BridgeValley Community and Technical College is an Equal Opportunity Employer and does not discriminate based on race, sex, age, disability, veteran status, religion, color, or national origin or genetic information unless otherwise prohibited by applicable law.

Click here for full statement.

Kanawha Valley Fame Program Application

Nondiscrimination Statement