SCSC Student Application Survey

THIS FORM REQUIRES NAMES, ADDRESSES, and PHONE NUMBERS other than your own.

Please view the form and gather information. You will be able to return and complete the form at a later date, if it is from the same devise. The program doesn't have a multiple devise setting at this time.

Onsite Training Arrival Date: June 13, 2018.

If you think you might have a conflict with the

SCSC Training Arrival Date (June 13, 2018),

DO NOT SUBMIT THIS APPLICATION.

PLEASE CALL THE SCSC COMMITTEE CHAIR,

HELEN GOODRICH, 308-219-0053

(Any variance will be assessed on a case by case basis.

For more specific information, see the Timeline or website

for deadlines and dates).

You are responsible for the cost of Conference and for arranging your own transportation home from Conference.

The deadline for this application and accompanying REQUIRED items is January 8, 2018.

SCSC Student Application

Question Title

* 1. Are you a

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* 2.
NAME

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* 3. Name you prefer to be called, if different:

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* 4. Gender:

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* 5. Date of Birth:

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* 6. What will be your age on June 13, 2018?

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* 7. Year of education completed as of June 13, 2018?

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* 8. Date School Term Ends:

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* 9. College you plan to attend next year:

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* 10. Please note: an email address and Facebook account is REQUIRED for communication and posting of assignments. Probationary acceptance will initially be communicated electronically. Please list your e-mail below.

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* 11. What is your Facebook contact name?

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* 12. Permanent Home Address:

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* 13. Your Present School Address (address where we can mail materials to you at college. Include: Name, Street, City, State & Zip)

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* 14. Which address should we use to send printed materials?

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* 15. Your Phone:

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* 16. Parent/Guardian (with whom you live when not away at school):

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* 17. Parent/Guardian Phone:

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* 18. Parent/Guardian Email Address:

Question Title

* 1. Are you a

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* 2. NAME

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* 3. Name you prefer to be called, if different:

Question Title

* 4. Gender:

Question Title

* 5. Date of Birth:

Question Title

* 6. What will be your age on June 13, 2018?

Question Title

* 7. Year of education completed as of June 13, 2018?

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* 8. Date School Term Ends:

Question Title

* 9. College you plan to attend next year:

Question Title

* 10. Please note: an email address and Facebook account is REQUIRED for communication and posting of assignments. Probationary acceptance will initially be communicated electronically. Please list your e-mail below.

Question Title

* 11. What is your Facebook contact name?

Question Title

* 12. Permanent Home Address:

Question Title

* 13. Your Present School Address (address where we can mail materials to you at college. Include: Name, Street, City, State & Zip)

Question Title

* 14. Which address should we use to send printed materials?

Question Title

* 15. Your Phone:

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* 16. Parent/Guardian (with whom you live when not away at school):

Question Title

* 17. Parent/Guardian Phone:

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* 18. Parent/Guardian Email Address:

* 2.
NAME