Indicates required field

Student Personal Information

If different from legal name
Birthplace
Gender

Student Contact Information

Home Address
Is your mailing address different from your home address?
Mailing Address

Parent/Guardian Information

Primary Contact Address
Secondary Contact Address

Education

Please attach a transcript from each source of high school credit.

List all high schools, alternative programs, home school, or colleges where you have taken courses, beginning with the most recent.

(MM/YY - MM/YY)
One file only.
10 MB limit.
Allowed types: pdf, doc, docx.
Do you have a second school to list?
(MM/YY - MM/YY)
One file only.
10 MB limit.
Allowed types: pdf, doc, docx.
Do you have a third school to list?
(MM/YY - MM/YY)
One file only.
10 MB limit.
Allowed types: pdf, doc, docx.
Have you ever received Special Education Services, Individualized Education Plan (IEP) or a 504 Plan?
Have you taken classes at Madison College previously?
(YY-YY)
Have you ever been dismissed, suspended, and/or expelled from a school or college for any violations or student conduct or safely?
(YY-YY)

Employment

Do you have a job?

Referral Information

Provide a name if possible

Criminal Background

Have you ever been arrested and/or convicted?
Do you currently have a pending court case?

Writing Prompts

Program Time Commitment

If accepted into the Gateway to College program, you MUST attend classes 4 days/week, Monday through Thursday 9am - 3pm.

Acknowledgement

By clicking submit, I certify that the information on this application is accurate and complete. Further, I understand and agree to the following:

  • If I have not provided accurate information or required materials, I may be denied acceptance into the program.
  • I cannot be enrolled in any other high school or an alternative high school program while participating in the Gateway to College Program. 
  • I am not eligible to apply for nor may I accept any forms of financial aid through Madison College while enrolled in the program.
  • If selected for the program, I agree to abide by Madison College’s Code of Student Conduct as well as the policies and procedures of the Gateway to College Program.

Madison College – Gateway to College Program, in its educational policies, programs, and procedures provides equal opportunity for all its students without regard to race, color, national or ethnic origin, religion, sex, sexual orientation, or disability.