Registration Form Nandagikendan Summer Academy June 25-28, 2018 at Fond du Lac Tribal & Community College
Boozhoo to all interested 2018 Nandagikendan Academy Participants!

We are excited to offer another summer Academy at Fond du Lac Tribal and Community College (FDLTCC).

Only 20 students will be selected for this opportunity. Eligible students are those entering grades 9-12 in the fall of 2018. Those who participate and complete the academy experience will receive a Certificate of Participation and a chance to win other prizes and along with having a real life experience of college life!

Email address *
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Email address *
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Student Information
Please fill out accordingly
Participants Name: *
Parent/Guardian Name: *
Home Address: *
Participant Cell: *
Age as of June 15, 2018: *
Parent Guardian Information *
Grade in 2018/19 SY *
Gender *
Tribal Affiliation
T-Shirt Size *
Dietary Restrictions *
Photo and video Release
By checking the box, I agree to allow Fond du Lac Tribal & Community College, to use video and or photographs taken of me during the Nandagikendan Summer Academy.
Commitment to Attend Summer Academy:
By checking the box below, I agree to and commit to attending the 2018 Nandagikendan Summer Academy @ Fond du Lac Tribal & Community College, June 25-28, 2018. If my commitment changes, I will notify Tara Graves at or 218.879.0701 prior to the June 25th check in date.
Email address *
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General Rules & Expectations:
These are rules & expectations that govern all persons participating in Nandagikendan. Review the following as you prepare for academy. Participants will not be admitted to the program until they have agreed to the following:
• Participation: The effectiveness of the Nandagikendan Academy depends on your commitment and 100% participation. The highest standards of behavior are expected along with full participation in all scheduled activities. • Smoking, Drugs and Alcohol: Smoking and tobacco use of any kind is not allowed. The use, possession, or concealment of non-prescription drugs and alcoholic beverages is strictly prohibited. Either violation of the rule- on or offsite during the program- will result in immediate dismissal.• Dress Code: Participants and staff must dress appropriately for all Nandagikendan Academy activities. The following are prohibited during the Nandagikendan Academy: Clothing that advertises alcohol, tobacco; or other drugs; clothing that conveys offensive messages of any kind; tube tops, crop tops, and low-cut tops of any kind; very short shorts/skirts; and pants/shorts that sag inappropriately. Nandagikendan Academy staff reserve the right to ask any participant to change clothes if they are deemed dressed inappropriately. • Damage to Property: Each participant is legally and financially responsible for any removal, defacing to public or private property. This includes property of fellow participants, advisors and staff, organizations, lodging, and camp facilities.• Transportation: Participants shall not leave campsite except while in transit to or from an official program activity or function. Participants may not use or be transported in private vehicles during any program function, without approval of a parent or legal guardian and the Nandagikendan Staff. We strongly discourage participants from driving their own vehicle to the academy. Those who do bring personal vehicles will turn in their keys to camp staff at the beginning of academy, and they will be returned on the last day. • Visitors: The Nandagikendan Academy involves day and evening scheduling. Visitors are not allowed.• Photo Release: I grant releases full permission to use images, recordings or any other record of my child while participating in Nandagikendan Academy in any medium. I agree that my name and identity may be revealed therein or by descriptive text or commentary. Inappropriate photos and or videos of self or other participants will not be tolerated or permissible to share via social media. • Relationships: The highest level of respect is expected at all times during the Nandagikendan Academy. No types of harassment-physical, verbal, racial, sexual, or otherwise- will be tolerated. Although we encourage the development of new friendships, the Nandagikendan Academy is not the place to develop relationships beyond friendship. No sexual or romantic contact will be allowed. • The Nandagikendan Academy Community: Specific guidelines relative to the special nature of the community setting will be outlined when you arrive and you will be expected to abide by those as well.
I have read and understand the General Rules listed above and my personal conduct at the Nandagikendan Academy will be consistent with them. I understand that failure to follow these guidelines may result in dismissal from the Nandagikendan Academy and travel home will be at my own expense.
Please (participant & Parent)sign & date below *
Understanding and agreeing with the Participant Responsibilities and expectations *
Email address *
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Emergency Contact/Relationship
Please list Parent/Guardian information below:
Name of Parent/Gaurdian *
Phone number of parent/guardian: Provide 2 numbers: *
Email address *
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Medical Information
Any information provided on this form will be held strictly confidential and will only be released to Nandagkendan Academy staff as a means of ensuring the safety and well-being of each participant.
Family Physician & Clinic Provider *
Do you have any allergies? or Medications if so please list: *
If you have been exposed to any communicable diseases during the three weeks prior to the Academy, please consult your physician and indicate disease or possible exposure: *
Any other information that we should be aware of to provide a safe experience for this participant? *
Please provide the following information about Insurance: Name, policy #, group # Phone # *
Please upload your current immunization record *
Medical Treatment Authorization
The program staff must have permission to provide routine non-surgical medical care for participants/staff. Permission is also required to secure certain services which program staff are not equipped to perform. These services include x-rays, laboratory tests, and emergency room services. Such services are readily available at nearby community hospitals.
The authorization needed is for the use of these services when deemed advisable by staff at the program. In the event of anything other than routine first aid issues, parents/guardians will be contacted immediately.
I hereby give permission to Nandagikendan Academy Staff to secure emergency medical and surgical treatment and routine non-surgical medical care for: (name of Participant and Parent guardian Signature/permission) *
Authorization to Dispense Non-Prescription Medication
If you so choose, you can give program staff permission to dispense non-prescription medication, including acetaminophen, ibuprofen and Benadryl, for routine needs. Staff will keep a record of the time of administration and the dosage given. Please note that participants are not allowed to keep any medications, even over-the-counter medications, they might bring to the Nandagikendan Academy with them. All medications must be checked-in with staff upon arrival and will be dispensed as directed.
I hereby give permission to the Nandagikendan Academy to dispense non-prescription Medication: *
Email address *
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Student Essay
In at least 250 words, please explain why you would like to attend this Academy. What are your intentions and expectations of the Academy? What are your future goals? Tell us why the Nandagikendan Academy would be helpful to you in your goals for the future.
(Please attach additional sheets if necessary.)
Summer Academy Essay *
Email address *
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Please list one or two references, (teachers, mentors, supervisors) that will attest to your accountability, responsibility, and readiness for a college experience. A short “student recommendation form” will be sent to them via email. Thank you. You will be notified by June 15, 2018 if you have been accepted into the Summer Academy!
Name & phone Number or email of Contact *
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