MEMBERSHIP APPLICATION | College Elite

Full Name

Birthday

Month

Day

Year

Address

Phone

Email

College/University Name

Student ID Number

File upload (Upload Picture of Student ID)

Major/Program of Study

Year in School

Freshman

Sophomore

Junior

Senior

Expected Graduation Date

Enrollment Status

Full Time

Part Time

Are you a first generation college student?

Yes

No

Household Income Bracket

Under $20,000

$40,000-$60,000

Over $80,000

Prefer Not to Say

Program Interests

Discount Program (e.g. apparel, events, products)

Monthly Care Packages

Emergency Financial Assistance (small grants)

Resources/Student Support Groups

Food Allergies

Yes - please list belo

No

(e.g. peanuts, tree nuts, gluten, dairy, shellfish, vegetarian, etc.) This information will be used to customize care packages and ensure safety.

Emergency Contact Name

Relationship

Phone

Optional: Brief Personal Statement (You may share any additional information about your financial needs, goals, or how this program could support you.

Signature & Acknowledgement

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I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that providing false information may result in the denial or termination of membership.

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