Student Success Initiative (formerly College Initiative) Interest Form

Student Success Initiative (formerly College Initiative)
Interest Form

The Student Success Initiative is a college access program and community for students with past criminal legal system involvement who are committed to pursuing higher education.

Please complete the interest form below and our Onboarding Specialist will contact you within 2 business days of submission to share more about our program and discuss a timeline for joining.

If you have any questions, feel free to reach out to our Manager of Outreach and Intake, TaNasha Williams, at

tanwilliams@jjay.cuny.edu.

Fields marked with an * are required

First Name

Last Name

Phone

Email Address

If "Other" please specify

If "Other" please specify

If from "Parole Officer" please specify their name and contact details if known (if unknown, please type: unsure

If from "Probation Officer" please specify their name and contact details if known (if unknown, please type: unsure

If from "P2CP", please specify their name(s)

Denisse MartinezMelannie InsignaresCarla BarrettOther

If other, please specify:

Have you ever been a part of Student Success Initiative (formerly College Initiative of CI) before?

Anything else you want to tell us?

If you are a provider or family member who is referring an applicant to College Initiative, please list your name and your relationship to the applicant.

Contact Information