Student Information

Question Title

* 1. What is your name? (First and last name)

Question Title

* 2. Birth Date

Question Title

* 3. Gender

Question Title

* 4. Please indicate how you identify yourself (American Indian, Asian, Black/African American, Native Hawaiian, White, etc.)

Question Title

* 5. What is your current GPA?

Question Title

* 6. Name of Middle or High School Attending Fall 2019

Question Title

* 7. What is your email address so that we can contact you? (Later we will ask for your parent/guardian's contact information.)

Question Title

* 8. What is you cell phone number (that you will use during the summer program)?

T