The College Opportunities Summit Intake Form

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This form will be used so that high school students can sign up for the Summer 2022 program. This year, we want to have a single form that includes students from high schools in counties other than Marin and Sonoma.

2/15/2022: This form is a clone of the form we used last year. We think it is a good idea to clone the form before starting a new application cycle so that we can begin with a fresh Responses page, and so that we can add information about the application cycle year.

5/4/2021: Going forward, this form will also be used to create Contacts for students who join the program year-round. We may need to deactivate the currently existing Institute application to not cause any confusion as to what form to use.  

Contact Information














Autosuggest Field Mapping






Demographic Information

Please format the date as MM/DD/YYYY.







Please answer "Yes" if your parents attended college in the United States but have not attained a Bachelor's degree or higher.






Student/Parent Release Page

(To be submitted by parents/guardians of minor students involved with 10,000 Degrees; and if student is 18 years or older to be signed by the student/participant.)
By submitting this form, you are giving permission for your student to work with 10,000 Degrees for the duration of the 10,000 Degrees program (namely, until your student attains a bachelor's degree). With your consent, 10,000 Degrees will receive information about your student from the school district to support and track his or her progress through the financial aid process. 10,000 Degrees shall not disclose confidential student information to any third party except for unidentifiable information for research and evaluation purposes and will maintain data records securely in accordance with state and federal law. Data items 10,000 Degrees requests may include the following:
  • Unrestricted communication with my student's teachers and staff regarding my student's behavior and academic progress
  • Student's Birthdate
  • Mailing Address
  • Student Email Address
  • Race/Ethnicity
  • Gender
  • School ID Number
  • Grade Point Average
  • High School Progress and Attendance
  • Class Schedule
  • English Learner Status
  • Financial Aid Application Award Eligibility
  • Cal Grant Award Status
  • Free and Reduced Price Lunch Status
  • Enrollment Status (Full/Part Time)
Your rights: You may refuse to sign this form. Inclusion of your student's participation is voluntary. Agreeing or not agreeing will not affect your student's school status in any way. In particular, you are not required to allow the release of your free and reduced price lunch eligibility to access these activities, and your refusal to allow access to this information shall not affect your eligibility for free or reduced price meals or free milk. You may cancel your participation at any time by informing 10,000 Degrees in writing, which will go into effect immediately. You have a right to receive a copy of this authorization.

Photo and Communications Consent: In addition, we ask for your authorization to use your student's likeness in a photograph or video in 10,000 Degrees's printed and digital publications and in promoting 10,000 Degrees's work. Any photograph using this likeness will become property of 10,000 Degrees and will not be returned. Through consenting, you will waive any and all rights to review or approve any uses of the images, any written copy or finished product, and acknowledge that you will receive no compensation. Photo consent is not required to participate in 10,000 Degrees.

Where to Get Further Information: To speak with someone from 10,000 Degrees, please call our main line at (415) 459-4240 or send an email to info@10000degrees.org.





It may take a little while for your form to process before you see the confirmation screen. Please do not hit "Submit" a second time. Thank you for your patience!