PRIZE : Program Application

PRIZE Program Application

If you are interested in participating in the PRIZE program, please complete this application. You can not save the application and come back to it later. It must be completed at one time. If you have any questions, contact the College of Education and Social Work at prize@wcupa.edu or call 610-436-2321.

Contact Information

Please make sure you have filled in all required fields with valid information.

First Name:

Last Name:

School Email Address:

High School Name:

Current Year in School:

Current High School GPA:

Program Information

Please make sure you have filled in all required fields with valid information.

Interested Major

Indicate your top certification interest:

Indicate your second certification interest:

Are you interested in attending the PRIZE Summer Teacher Academy?

(Note: The Summer Teacher Academy is optional for PRIZE participants)

Yes No

Do you speak another language?

Yes No

Which Language?

Work History Information

Please make sure you have filled in all required fields with valid information.

Please fill in any work experience you have had during high school. If you have less than three, leave blank the additional spaces.

Work Experience 1

Dates:

Location:

Brief description of job responsibilities:

Average hours per week:

Work Experience 2

Dates:

Location:

Brief description of job responsibilities:

Average hours per week:

Work Experience 3

Dates:

Location:

Brief description of job responsibilities:

Average hours per week:

High School Counselor Information

Please make sure you have filled in all required fields with valid information.

Please provide the name and email address of your School Counselor who will be completing the recommendation form. The form will be sent to them using this information.

School Counselor First Name:

School Counselor Last Name:

School Counselor Email Address: