Pathway to Law School Interest Survey Students interested in the Law School Pathway should complete the following information and submit. This form will be the way the faculty will announce activities, workshops, and field trips. Students will also be enrolled in a Canvas site for the Law School Pathway. Student First Name Student Last Name COC Student ID number Home Address City State - Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Telephone Number COC Canyons Email (Note: all COC correspondence will go to your COC email address) When was your first semester at COC? (Ex. Fall 2016) DEMOGRAPHIC INFORMATION Your responses to the following questions are greatly appreciated. Demographic information is needed to support and identify funding requirements for the Law Scholars Program. Are you Hispanic/Latino of any race? Yes No If you are non-Hispanic/Latino, which race best describes you? (Please choose all that apply.) African-American or Black American Indian/Alaska Native Asian Asian Asian Asian Asian Native Hawaiian/Pacific Islander White, Non-Hispanic Other Ethnicity Other Are you a veteran? Yes No Are you a current or former foster youth? Yes No Do you receive any of the following services or belong to any of the following programs? (Please choose all that apply) BoG Fee Waiver CalWORKS EOPS STAR STARAR STAR None Gender Age ENTER FULL NAME BELOW (this will serve as your digital signature). I understand that I will be entering into a special program designed to help prepare students for admission to the participating law schools: University of California, Berkeley; University of California, Davis; University of California, Irvine; University of California, Los Angeles; Loyola Law School; Santa Clara University School of Law; University of San Francisco School of Law; University of Southern California Gould School of Law; Pepperdine Caruso School of Law; Chapman Fowler School of Law; McGeorge University School of Law; Southwestern Law School; University of San Diego School of Law; University of California, College of Law, San Francisco; and Western State College of Law. I understand that by participating in this program, I will not have guaranteed admission to the universities or the law schools mentioned. Leave this field blank