(Please enter your full first name - no abbreviations or nicknames)
(Please enter your full last name - no abbreviations or nicknames)
This question requires a valid number format.
All further communications will be sent to your email. Please check that the email is correct before submitting. This question requires a valid email address.
This question requires a valid email address.
This question requires a valid date format of MM/DD/YYYY.
Please start typing your school name, and select your school from the available options.
(Please add the full name of the School Counselor, Teacher, or Administrator helping you with your SIELP interest form.)
Please check that the email is correct before submitting. This question requires a valid email address.
Once you click submit, a copy of this form will be emailed to the student and educator captured on the interest form. Your confirmation message will also include a link to the required CUNY Application.