Middle Peninsula Summer Regional Governor's School Information
My child will be in Grades 3-7 for the 2016-2017 school year. Please add me to your MPSRGS Information list. By completing this form, I give permission to receive updates via email about the MPSRGS application process for the 2016-2017 school year. Please complete this form to be sure we have a current email address for your child.
Please call us at 804-693-4795 to be put on our phone/mail list for all this important information if you are not able to participate online.
We will only be sending this information via email unless you contact us to make a non-computer arrangement.
Student Last Name
Your answer
Student First Name
Your answer
Student ID Number (5-digit Lunch Code)
Your answer
Student Current Grade Level
Student Current School
Parent/Guardian Name (First Last)
Your answer
Parent/Guardian Email Address
Your answer
Second Parent/Guardian Email Address
Your answer
Family Mailing Address (include PO Box or Street)
Your answer
Family Mailing Address: City (Hayes, Gloucester, Achilles, etc.)
Your answer
Family Mailing Address: Zip Code
Your answer
Parent Phone number(s)
Your answer
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