Application for High Rocks Academy Camp

Application for High Rocks Academy
First Name:*
Last Name:*
Preferred Email Address:

PersonalAlternate
Personal Email:
Alternate Email:
For example, your parent's email
Primary Address Street:*
City:*
State:*
Zip Code:*
County:*
Preferred Phone Number Type:

HomeCellWorkI do not have a phone
Home Phone Number:

Area CodePhone Number
Cell Phone Number:

Area CodePhone Number
Work Phone Number:

Area CodePhone Number
Date of Birth:*
What school do you attend?
High School Graduation Year:*
What is your t-shirt size?*

SMLXLXXLXXXLOther
I am...*

in 7th or 8th grade and would like to apply for Camp New Beginnings.in 8th-12th grade and would like to apply for Camp Steele.
I am in:*

7th grade8th grade9th grade10th grade11th grade12th grade
Tell us about your living situation

I live with one or both parentsI live with someone other than my parent(s)I am living on my own/support myself independentlyI am part of the foster care program or otherwise in the custody of the stateI am homeless (see definition below)Other
It is important to us that low income families are part of our programs. Does your family receive public assistance? For example: public assistance to help with rent, food, or heat.

YesNo
Parent/Guardian Full Name:*
Parent/Guardian Home Phone Number:*

Area CodePhone Number
Parent/Guardian Cell Phone Number:

Area CodePhone Number
Parent/Guardian Email:
Parent/Guardian Occupation:
2nd Parent/Guardian Full Name:
2nd Parent/Guardian Home Phone Number:

Area CodePhone Number
2nd Parent/Guardian Cell Phone Number:

Area CodePhone Number
2nd Parent/Guardian Work Phone Number:

Area CodePhone Number
2nd Parent/Guardian Email:
2nd Parent/Guardian Occupation:
Will you be a first generation college student?

Yes, neither of my custodial parents graduated with a 4-year degreeNo, one or both of my custodial parents graduated with a 4-year degreeMaybeIt's complicated, or I'm not sureOther
Citizen Status

I am a US citizenI am a US permanent residentI am an international studentI am a recipient of D.A.C.A. (Deferred Action for Childhood Arrivals/ Dreamer)Other
Gender

FemaleMaleTrans and/or non-binary,I prefer not to sayOther
If you would like to tell us about your preferred pronouns, please do so here.
Are you a member of a military family?

YesNoI don't know
Are you a member of a Veteran family?

YesNoI don't know

Identity

	Me	Somewhat Me	Not Me	I'm not sure
Differently-abled, Learning Disorder, or other
LGBTQIA+
Hispanic or Latino/a
White
Black or African
American Indian or Alaskan Native
Middle Eastern or North African
Hawaiian
Asian
Non-native English Speaker

What other aspects of yourself would you like to share?
Ex: I am an Appalachian, I am a musician, I am an athlete, etc.
A little about you...

High Rocks camps are fun, vibrant, rigorous, challenging, and engaging. In order for us to make the difficult decision on who is selected to come to these camps, we need to know as much as we can about you. Please take the time to answer these questions as completely and honestly as you are able. This is your chance to shine. There is no word limit on the following questions.
What do you know about High Rocks? Why do you want to be a part of it?*
What are your three best qualities? Why? *
What would you like to change and/or work on about yourself? Why?*
Tell us about a dream you have for yourself or your community, school or world.*
What is something many people don't know about you and would be surprised to learn?*
Please answer one of the following essay questions using between 250-750 words
Write about a person who has inspired you and why. How has the example they have set helped change the way you live your life?

0/750
Tell us about a challenge that you faced and how you dealt with it.

0/750
RECOMMENDATION FORM

You need to ask someone (no parents or relatives) to submit an online recommendation form for you. You can ask a teacher, coach, pastor, community leader, or another person who knows you well. Please list the NAME, RELATIONSHIP, and PHONE NUMBER of the person you plan to have complete this recommendation form for you that we can contact if we have questions.
Find an online recommendation form at: https://form.jotform.com/70585323103145
Name:*
Phone Number:
Email
example@example.com
Relationship to you:*
Should be Empty:

Application for High Rocks Academy

A little about you...

RECOMMENDATION FORM