Dr. Charles W. Donaldson Scholars Academy Summer Bridge Program 2018
Thank you for your interest in our summer bridge program. We are so excited that you have chosen to participate in the program.
Enrollment Form
Would you like to receive communication via text? We will share program updates, deadlines, and send simple reminders. Message and data rates will apply.
Cell number you would like to receive messages:
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Additional cell number you would like to receive messages:
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Student's First Name *
Your answer
Student's Last Name *
Your answer
Grade Level During the 2017-2018 School Year *
This is the grade you just completed
Your answer
School Attended During 2017-2018 School Year *
Your answer
What college do you plan to attend? *
Date of Birth *
Your answer
Gender *
Your answer
E-Mail Address That You Check Regularly *
This will be the primary form of communication!
Your answer
Address: *
Physical Address, City, State, Zip Code
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Cell Phone Number *
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Home Phone Number
Your answer
Parent/Guardian Name (A) *
Your answer
Daytime Phone Number
Your answer
Daytime Cell Number *
Your answer
E-mail Address *
Your answer
Parent/Guardian Name (B)
Your answer
Daytime Phone Number
Your answer
Daytime Cell Number
Your answer
E-mail Address
Your answer
Social Security Number( for students who will be 9th, 10th, 11th, or 12th grade students this fall) or College ID Number (for students starting college fall 2018) *
This Is Needed for Students to Have Access to Testing and ID cards on Campus
Your answer
Alternate Emergency Contact:
Name *
Your answer
Relationship: *
Required
Daytime Phone *
Your answer
Evening Phone *
Your answer
Cell Phone *
Your answer
Parent's Signature *
Please Type Full Name
Your answer
Date *
Your answer
General Student Information
In order to make your child's experience at CWDSA the best possible, we would like some information from you. The CWDSA staff will use the information on this page to enhance your student's experience.
1. Has the student ever been away from home without a parent? *
Required
If yes, how did he/she cope? *
Your answer
2. Does the student have any disabilities or special challenges? *
(i.e. Physical, emotional, learning, developmental, social or behavioral)
Your answer
3. Does the student have any hobbies or special interests? *
Your answer
4. Is there anything else we should know about the student to make his/her stay more enjoyable? *
Your answer
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