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APPLICATION
The Collaboration of SDSU, Cal-SOAP,
UCSD, and Bayview Baptist Church aims
to provide a comprehensive SAT test and
college/university preparation program
for 100 San Diego area high school
students. In particular, we are committed
to providing services to students from any
of the following backgrounds:
Due April 10 , 2015
• Students from low-income families
• Students from families in which they would be the first to attend college
• Students from schools with documented low college eligibility or
participation rates within the San Diego region
• Students from historically underrepresented backgrounds within UCs,
CSUs, private colleges and universities
• Students with a minimum of 2.5 GPA
TO AVOID DISQUALIFICATION, PLEASE COMPLETE ON LINE OR LEGIBLY AND NEATLY WITH BLACK OR BLUE INK
Last Name_______________________________________ First Name_______________________ Nickname (optional)______________________
Parent/Guardian Last Name_________________________________________First Name______________________________________________
Mailing Address _________________________________________________________________ Unit/Apt # (if applicable)___________________
City _____________________________________________________________________________State and Zip Code______________________
Home Ph (______) __________________________________________ Alternate Ph (______) __________________________________________
Student E-mail Address___________________________________________ Sex M
College weighted GPA (most recent)________________ F
Birth date (mm/dd/yyyy) _____________________
Expected Date of Grade Level in T-Shirt
Graduation: June 20________ 2014-2015 ___________Size _________
School you currently attend in 2014-2015 ____________________________________________________________________________________
Parent E-mail Number of people
Address _____________________________________________________ in household ___________ Annual Family
Income $__________________________
Do you qualify for free and/or reduced lunch at school? ...................................................................................... Yes No
Are you a first generation college-bound student? Meaning, your parents and older generations
didn’t complete a college degree and you/your generation would be the first to earn a college degree?............. Yes No
I will need a bus/trolley pass.................................................................................................................................. Yes
Please check all with which
you most closely identify
Are you currently participating
in outreach programs, such as:
African American  Asian/Pacific Islander  Latino/a/Hispanic White/Caucasian 
Filipino/a Native American/Alaskan Native 
Other, specify ___________________
YMCA  Price Community Scholars 
AVID 
GEAR-UP 
Student: Please tell us about yourself. Why do you
want to attend college and what do you tentatively
plan to study? Why do you want to participate in
SWAG and what effort will you put in to SWAG?
Are there challenges you have overcome or hope
to overcome, such as coming from a low-income
background, being first in your family to attend
college, etc?
Parents: If any recent circumstances have affected the
family financially (loss of job/income, loss of home,
etc.) you may include a separate written explanation
of any pertinent information.
Signature: Only committed students will be admitted
Educational Talent Search 
UC EAOP 
Upward Bound 
Other, specify  ___________________
• Attendance is mandatory for every session of the program. I must participate in the
Orientation, pre-test and post-test, and every class session.
• I will need my own transportation to and from the site (Bayview Baptist Church, 6134
Benson Ave, SD CA 92114.) *Bus/trolley passes may be available.
• I will sign a waiver granting SWAG access to my future PSAT and SAT scores. I also commit
to take the PSAT (if applicable) and SAT and submit those scores to SWAG.
• I agree that the SWAG Program has the right to publish photographs of students for publicity
purposes.
Completing this form can be done on-line. Please print the completed form, sign and
date it and either scan and email, fax or mail it to
CAL SOAP of San Diego
Attn: SWAG, 6735 Gifford Way, Room 14, San Diego, CA 92111 or
E-mail to: kkwhitaker@ucsd.edu or
Fax to: 858-569-1136, Attn: SWAG (Confirm arrival of fax by calling 858-569-1866)
to the SWAG Program. If accepted, my parent(s) and
I understand the following:
Parent’s/Guardian’s Signature _________________________________________________________________ Date ___________________________________
Student’s Signature _________________________________________________________________________ Date ___________________________________