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* 1. First Name

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* 2. Last Name

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* 3. Date of Birth

Date

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* 4. Email Address

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* 5. Cell Phone Number

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* 6. Parent or Guardian Name (First and Last Name)

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* 7. Parent or Guardian Phone Number

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* 8. Parent or Guardian Email Address

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* 9. School

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* 10. Grade

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* 11. Instagram Handle

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* 12. In no more than five sentences, describe an issue you believe affects Black students across the globe.

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* 13. What do you hope to gain from this experience?

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* 14. In no more than five sentences, describe how you believe your participation in this program will benefit fellow JPS scholars (current and future), people in your neighborhood, and/or the City of Jackson.

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* 15. If you had unlimited time and money, where would you go and why?

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* 16. How do you like to communicate with your peers and friends? (Check all that apply)

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* 17. What media platforms and creative careers most interest you? (Check all that apply)

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* 18. What is the most important thing you have learned from a peer, friend, or classmate so far in your life? How has that learning influenced you or changed the way you think or act?

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* 19. Have you ever traveled outside the country or do you have plans to travel outside the country in the next 12 months?

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