International Affairs Summer Camp – Application Form

University of Central Arkansas
Conway, Arkansas
July 14-19, 2024

Student Name*
First Last
Student Mailing Address*
Street Address Address Line 2 City State ZIP Code
Student (Personal) Email Address*

NOTE: Since high school student email accounts are often blocked from receiving email messages from external email accounts, please provide a personal email address if at all possible.
Student Phone Number*
Name of High School (or home school)*
High School County (e.g. Pulaski County)
Parent or Guardian Name (1)*
First Last
Parent or Guardian Phone Number (1)*
Parent or Guardian Mailing Address (1)*
Street Address Address Line 2 City State ZIP Code
Parent or Guardian Name (2)
First Last
Parent or Guardian Phone Number (2)
Parent or Guardian Mailing Address (2)
Street Address Address Line 2 City State ZIP Code
What is the student's date (month, day, year) of birth?*
What is the student's gender?*
- Male
- Female
Is the student in a Gifted & Talented Program?*
- Yes
- No
What grade in high school will the student be starting in the upcoming school year?*
- 10th Grade
- 11th Grade
- 12th Grade
What is the student's race/ethnicity?*
- Caucasian (White)
- Hispanic (Latino)
- African-American (Black)
- Native America (American Indian)
- Asian-American
- Other
What is the student's tee-shirt size? (Please choose one option below)*
- Small (S)
- Medium (M)
- Large (L)
- Extra Large (XL)
- Double Extra Large (XXL)