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FRESNO STATE SUMMER PROGRAM 2024
This camp is taking place from
May 24 - 26, 2024
and is hosted by College Assistance Migrant Program and Lyles Center for Innovation and Entrepreneurship at
California State University, Fresno.
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* Indicates required question
BOLD CAMP
K-16 Fresno-Madera Collaborative
Program Name / Nombre del Programa:
*
BOLD CAMP
Student's First Name / Nombre del Estudiante
*
Your answer
Student's Last Name / Apellido del Estudiante
*
Your answer
Student Email Address / Correo Electronico del Estudiante
*
Your answer
Ethnicity / Etnicidad
*
White (Non-Hispanic)
African American or Black
Hispanic or Latino
Asian American
Native American or Alaska Native
Pacific Islander
Middle Eastern or Arab
Other:
T-shirt Size /
Talla de camiseta
*
XS
S
M
L
XL
XXL
Other:
Gender / Genero
*
Your answer
Current Age / Edad Actual
*
Your answer
Migrant ID number
(if applicable)
/ Numero de ID Migrante (
si es aplicable
)
Your answer
Date of Birth / Fecha de Nacimiento
*
MM
/
DD
/
YYYY
Student’s Contact Phone / Numero de Telefono del Estudiante
Your answer
Name of High School Attending Now / Nombre de la Escuela Actual
*
Your answer
Name School Attending in Fall / Nombre de la Escuela que acudira en el otoño
*
Your answer
Current Grade in High School/
Grado actual en la escuela secundaria
*
9
10
11
12
Other:
Are you presently under any medication
(Indicate the medication below)
Actualmente estas bajo algun medicamento (Indica el medicamento abajo)
*
Your answer
Are you allergic to any medication
(Indicate the medication below)
Tienes alguna alergia a algun medicamento (
Indica el medicamento abajo)
*
Your answer
Presently wear contact lenses?/Actualmente usa lentes de contacto?
*
Yes/Si
No
Presently wear glasses?/ Actualmente usa lentes?
*
Yes/Si
No
Do you have any dietary restrictions or allergies we should be aware of?
(Indicate the restrction)
¿Tiene alguna restricción dietética o alergia que debamos tener en cuenta?
(Indica la
restricción dietética o alergia
abajo)
Your answer
Mother’s Name or Guardian/Nombre de la Mama o Guardian
Your answer
Contact Phone/Numero de Telefono
*
Your answer
Father’s Name
or Guardian
/Nombre del Padre
o Guardian
*
Your answer
Contact Phone/Numero de Telefono
*
Your answer
Home Address, City & Zip/Domicilio, Ciudad y codigo postal
*
Your answer
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