Which session are you applying for? *
 Spring Session (May 21st - 25th, 2008)
 Summer Session (August 13th - 17th, 2008)

 First Name *

Last Name *

Nametag Preference *

 Date of Birth *

Permanent Address *

City *

 State *

Zip Code *

Gender *

Phone Number *

Fax Number

Cell Number *

Student Email Address *

Current School *

Current Year in School *

Area of Specialty *

Year of High School Graduation *

Extracurricular Activities and/or Community Involvement: *

Emergency Contact Name *

Relationship *

Emergency Contact Phone # *

Emergency Contact Cell # *

Please list any medical conditions, or special needs we should know about.
If none, please state.