Thank you for your interest in EAOP's Senior Summit!

Upon completion of both the Online Registration Form and Waiver Forms, you will be given a confirmation email with further details closer to the day of the event. If you have any questions, please contact Norman Borgonia via email (norman.borgonia@ucr.edu) or phone (951.827.7286).

Parent-Student Orientation - Sunday July 16 or Tuesday July 18
Program Dates -
 Monday, July 31 to Thursday, August 3 (100% ATTENDANCE REQUIRED)

* 1. Student's First Name:

* 2. Student's Last Name:

* 3. Student's date of birth:

Date:
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* 4. Student's Gender

* 7. Student's High School Graduation Year:

* 8. Student's T-shirt Size:

* 9. Do you qualify for free/reduced lunch at your school?

* 10. Do you belong to any of the followingCommunity Based Organizations or Partnerships?

* 11. Student's Primary Email:

* 12. Please confirm Student's Email:

* 13. Student's Primary Phone Number:

* 14. Parent's Primary Email:

* 15. Parent's Primary Phone Number:

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