SubmCompleting this form enrolls you in your employers College Bound Benefit Program.  By completing this enrollment form, typing your name in the signature box and checking the Acknowledge Terms box below you, and your parents if you are under 18, agree to the terms and conditions outlined in your individual employers College Bound Program.  Go to your employers College Bound web page to review or download their College Bound Program document.   A copy of your employers College Bound Program document will also be e-mailed to you upon submission of this form.  

It is important that we have complete contact information for you as a new College Bound employee and also contact information for your parents if you are under 18 years of age so we can keep you informed about this important college planning benefit. 

*We ask for your Social Security # for long term contact purposes.  If you are hesitent to provide, just type NA.  Our reasoning;  For financial aid planning purposes, it may be 4 or 5 years after you leave your employment that you decide to claim your benefits so, we need to have a way to find you if you move multiple times, change schools, your parents move, you get married and have a name change, etc. 

All fields are set as "required".  If you can't complete or don't need to complete a required field because you are 18 or older, please type NA for Not Available in order to submit the form with available information.



* Required fields
Name *
E-mail Address *
Your Birth Date *
Your Address *
Your City *
Your State *
Your Zip Code *
Your Cell Number *
Parents Approve Your Participation? (If under 18) *
Student Signature *
Parent Signature *
Current grade in school (9th - 10th - 11th - 12th - 13th Etc.) *
Your Social Security # *
Employer Name / City *
Mom's Name *
Dad's Name *
Mom's Cell # *
Dad's Cell # *
Mom's Email *
Dad's Email *
Do you want help/advice with the college funding/planning process? *

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