Application Step 1 of 7 14% Applicant and Family InformationStudent's Name* First Last Preferred Name (if not first name) Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Student Cell PhoneStudent Email* Date of Birth* MM DD YYYY Please identify family members or others who are supporting your application to EDGE Advance. Also, indicate whether EDGE Advance may discuss your application directly with each person:Name* First Last Relationship*Phone Number*Email Address* EDGE May Contact?*YesNoAdd Another Family Member?*YesNoName of Family Member* First Last Relationship of Family Member*Family Member Email* Family Member Phone*EDGE May Contact?*YesNoReferred By* EDUCATIONEDGE Advance invites applicants who are enrolled in, or plan to enroll in, a college or university in the Chicago metropolitan area. If you are willing to explore admission to a school in Chicago but have not yet chosen one, we will consider your application. Please describe your academic preparation to date:High School (most recent attended): School Name*City*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDate Graduated* MM DD YYYY Did you complete a GED as an alternative to high school?*YesNoPlease indicate the date you successfully passed all exams related to the GED:* MM DD YYYY College/University ExperienceCurrent EnrollmentName of School*Enrollment Status* Full Time Part Time Program of Study*Please list any colleges in which you have previously enrolled: STRENGTHS, PLANS AND SUPPORTS:In order to help us determine if an EDGE Advance experience is right for you, please take some time to share with us your thoughts about yourself and your vision for the future. What areas of study or what careers interest you? List as few or as many as you would like.*What excites you about going to college?*What experiences have prepared you to be successful in college and beyond?*I am committed to living in a substance-free community*YesNo OTHER INFORMATIONWhat experiences have prepared you to be successful in college and beyond?EDGE Advance works with you to strengthen skills in many areas of your life. Each member of our community may want additional support in certain areas. Indicate the areas in which you might want addition support Learning Academic SkillsDeveloping Strong RelationshipsRecovering from AddictionsBuilding Physical HealthBecoming Emotionally ResilientMastering Life ManagementExploring Careers and Service Opportunities If you have previously received, or are receiving, specific support (e.g. substance abuse or mental health treatment, 12 Step Program, academic preparation/tutoring, etc.) in any of the above areas, please indicate which area and from whom you received the assistance. Support AreaLearning Academic SkillsDeveloping Strong RelationshipsRecovering from AddictionsBuilding Physical HealthBecoming Emotionally ResilientMastering Life ManagementExploring Careers and Service OpportunitiesNoneSource of SupportSubstance AbuseMental Health Treatment12 Step ProgramAcademic Preparation/TutoringProviderAdd More?YesNoSupport Area 2Learning Academic SkillsDeveloping Strong RelationshipsRecovering from AddictionsBuilding Physical HealthBecoming Emotionally ResilientMastering Life ManagementExploring Careers and Service OpportunitiesSource of Support 2Substance AbuseMental Health Treatment12 Step ProgramAcademic Preparation/TutoringProvider 2Support Area 3Learning Academic SkillsDeveloping Strong RelationshipsRecovering from AddictionsBuilding Physical HealthBecoming Emotionally ResilientMastering Life ManagementExploring Careers and Service OpportunitiesSource of Support 3Substance AbuseMental Health Treatment12 Step ProgramAcademic Preparation/TutoringProvider 3 THE COMMUNITY AND YOU:Our community is a place where you give and receive support from others who are on a similar path. Please write a short essay (200-500 words) about your vision of living in a community. You may choose to describe what you might contribute to the community and what you would like to gain from the community, you may want to discuss your “ideal community”, or you may go in a different direction altogether. Essay* Additional CommentsPlease add any other information that you would like EDGE Advance to consider in the application process.