Summer Exploration Programs - Supplemental Questionnaire

Please complete the below questionnaire to select your program topic of choice and ensure your housing and dining needs are accommodated.

Participant Information

Today's Date

mm/dd/yyyy

Given Name

Middle Initial

Family Name

Date of Birth

mm/dd/yyyy

Gender

Preferred Pronouns

T-Shirt Size

Cell Phone Number

If you (the participant) will have an active number while in the US, please enter the phone number you can be reached at.

Email Address

School Information

What grade will you enter Fall 2024?

High School Name

City & Country

Please list where your high school is located.

Parent/Guardian 1 Information

Parent/Guardian 1 Full Name

Parent/Guardian 1 Relationship

Parent/Guardian 1 Email Address

Parent/Guardian 1 Cell Phone

Parent/Guardian 1 Primary Language

Permission to Check Student Out?

Is this parent/guardian authorized to check out the student from the program?

Parent/Guardian 2 Information

Parent/Guardian 2 Full Name

Parent/Guardian 2 Relationship

Parent/Guardian 2 Email Address

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Primary Language

Permission to Check Student Out?

Is this parent/guardian authorized to check out the student from the program?

Housing Preferences

Roommate Gender

Are you comfortable living with a student whose gender is different than yours?

Which statement best describes you (the participant)?

Do you prefer to have roommates with similar academic interest?

Academic Area of Interest

Dietary Restrictions

Food Allergies

Dietary Needs

Other Dietary Needs

Disability Accomodations

Accomodations Needed

I currently receive accommodation at my school. In order to participate in the program, I need to speak with the Services for Students with Disabilities office.

Topic Selection

See here for a description of topics.

Session

Release Form

Please sign and upload this release form. If under 18, your parent or legal guardian must sign.

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