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2014 SUMMER CAMP PRE-APPLICATION
Space is limited. Middle school students interested in the Cheza Nami summer Camp-2014 are invited to complete the pre-application form below. Selected students will be informed on July 7th. Selection will be based on the level of funding after the close of the fundraising campaign. If our fundraising goal is reached, our camp will be able to accommodate up to 45 students and it will be on a first come first served basis. Completion of the form below does not guarantee you selection for the program.
Applicant Name
*
First
Last
Birth Date
*
Please provide the applicant's date of birth.
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
School
*
Please complete the applicant's school and the city where the school is located
Current Grade? Select One
*
6th grade
7th Grade
8th Grade
Parent Name
*
First
Last
Parent Email
*
Parent Primary Phone Number
*
Parent Alternative Phone Number
*
Submit Pre-Application form
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