FALL 2004 Project AIM Re-Entry Form
for Update Information:

First Name: Middle Initial:
Last Name:

SOCIAL SECURITY NUMBER:

MAILING ADDRESS:
P. O. Box Village:
Guam, Zip:

STREET ADDRESS:
Village:
Guam, Zip:

CONTACT NUMBERS:
Home: Work:
Cell or Pager:   E-mail Address:

MILITARY VETERAN No Yes

WHAT ASSISTANCE WILL YOU NEED? (Check all that apply.)
    Counseling
    Workshops
    Cultural Enrichment
    Tutoring [(subject(s)]
    Mentorship Program
    Transfer Center (I am planning to graduate from GCC & transfer to the following
4-year institution.)

I am majoring in the following educational program:

I have earned the following credits to date:

Number in my family     Yearly Taxable Income

By submitting this application I promise to adhere to current Project AIM program
requirements as outlined in my handbook: