Student Information

Please check this account for Project LEAP notifications

Educational Information
Income & Residency (Per Funder Request)
Finding a Mentor

i.e. specific race, sexual orientation, etc.

(Check all that apply)

Referral Information

If you were referred, please list the name and department if applicable

Agreement

By submitting this form, I certify that the information in this application is correct to the best of my knowledge. I grant the Pasadena City College Project LEAP program the permission to verify and/or obtain the records necessary to document information as well as to receive information regarding my college and academic status from other college departments. I am aware that Project LEAP may consult with my assigned mentor, and faculty and staff to discuss certain aspects of my situation to assist with the successful completion of academic, personal or career goals.