EmailMe Form - 2017 TIPPS Camp Application

STUDENT INFORMATION
Student Name *
First MI Last
Age *
Preferred First Name
Example: Katie for Katherine
Birthday *
MM / DD / YYYY
High School *
Current GPA: *
College *
Declared Major *
Email *

Confirm
Year in school (Fall 2017)
T-Shirt Size *
XS
S
M
L
XL
2XL
3XL
4XL
Student Address *

Street Address City State / Province / Region Postal / Zip Code
Sex *
Male
Female
Student Cell Phone *
### - ### - ####
How did you hear about TIPPS: *
Student Secondary Phone *
### - ### - ####
What is the best way to contact you? *
Phone call
Text
Email
What is your dietary lifestyle?
Omnivore (eats plans & animals)
Pescatarian (eats fish but no other meat)
Vegetarian (eats no meat)
Vegan (eats no animal products at all - includes all meat, all dairy, and eggs)
FREE RESPONSE QUESTIONS
Please write a few sentences to one paragraph for each short response question. Your answers to these questions will be published in the camp directory which is given to all TIPPS attendees.
Hobbies *
What are you passionate about? *
What 1 or 2 issues in the world pose the greatest threat to young adults? Have you already taken action to address this problem? Do you have any ideas how to help? *
Why are you applying to TIPPS? What do you hope to learn and get out of the experience? *
Please upload a wallet-sized photo of your face for the camp directory. *
EMERGENCY CONTACT INFORMATION
Contact Name *
First Last
Relationship to Participant *
Contact Cell Phone *
### - ### - ####
Contact Email *
Health/Accident Insurance:
Do you have any dietary restrictions or allergies to any foods that we should be aware of?
If so please list below.
Do you have any allergies, reactions to medications or other medical limitations? *
If yes, Identify and explain:
Do you have any current or past physical or mental conditions, which might limit your participation in TIPPS activities? *
If yes, identify and explain:
PRE TIPPS EVALUATION
Please take this quick survey so we can know a little more about you! This is only for informational purposes and will not be shared with anyone other than qualified staff members.

Evaluate the following statements. *

	Yes	No
I know at least 5 people who have graduated from college.
Are you planning on attending a 4 year university?
I am the first person in my immediate family to go to college.
I am the first person in my immediate family to graduate high school.

ATTENTION: Please be aware that if accepted, our generous sponsors are contributing $550.00 for you to attend TIPPS Camp on August 15th-18th. Please notify us by July 14th 2017, if for some reason you are unable to attend TIPPS Camp. If you do not notify us by this date, you may be responsible for the $550.00 cost to attend. It is important for you to notify us by July 14th 2017, to avoid any charges. By signing below you are agreeing to these terms. *
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Submitting your application
Enter the CAPTCHA text and press the Submit button. You will receive an email indicating your application was successfully received. Check your email frequently for any updates on your application. For any questions or concerns, contact us at tipps.camp@gmail.com
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STUDENT INFORMATION

FREE RESPONSE QUESTIONS

EMERGENCY CONTACT INFORMATION

PRE TIPPS EVALUATION

Submitting your application