Please complete the following questionnaire. Once completed, it will be processed, and you will be asked to provide your credit card information. You will be charged a one-time $496 administrative fee (used to afford the rigorous updates needed to maintain this site, as well as take photographs and assist in general placement.)

If you are not accepted in our program, your credit card will be refunded. If you are accepted, you will receive a one-time credit over your first monthly stipend to reimburse this expense. Mostly the fee is used to weed out candidates who are not serious, as well as keep undesirable elements away. It is also a deterrent against spam bots and artificial crawlers.

NAME

YEAR OF BIRTH:

CITY:

FAVORITE BAND (Maybe make this a pull-down with only Cold Play listed)

BRACKET FACTOR (California only) – Pull down with "X, R, 9 or *414

AGREE TO OUR TERMS OF SERVICE (links to this page, no TOS exists)

SUBMIT

 


This innovative program is under tentative funding from the State of California, as authorized by a joint house bill passed April 2nd, 2008, but it is administered by outside agencies. Complaints should not be directed to the state itself, but rather the agencies acting all over her behalf.

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