Student Application Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Base Camp Coding Academy
802 Central Street
Water Valley, MS 38965
http://www.basecampcodingacademy.org

Thank you for applying to BCCA! This is the application form. Your nominator MUST fill out the Nomination Form (https://forms.gle/geDvgfVX9bjoCTs2A) before you can continue forward in this process. Once you fill out this application, you will be given information on software development careers. Please come prepared to the interview to share what you learned, and tell us why you think you would make a great programmer. We will be contacting you via email to setup your first interview, so make sure to check your email for follow-up!

Base Camp is a targeted program for recent high school graduates with the ability to commute to Water Valley. Space at BCCA is limited, and this is a huge opportunity and responsibility. Please help us understand why you are the right person to receive this opportunity. In order to be eligible to apply you must have first been nominated by a teacher, employer, or other qualified individual who can speak to your abilities.

Email *

Name: *

School you currently attend: *

Demographic Information (Optional)

This section is optional. The information collected in this section is not used as part of the eligibility or admissions process. This information is only used to inform future recruitment efforts.

Gender (Optional)

Female

Male

Prefer not to say

Other:

Clear selection

Race (Optional)

Asian

American Indian or Alaskan Native

Black or African American

Native Hawaiian or other Pacific islander

White

From multiple races

Other:

Clear selection

Ethnicity (Optional)

Hispanic or Latino or Spanish Origin

Not Hispanic or Latino or Spanish Origin

Clear selection

Eligibility

Answer each question below to confirm your eligibility.

Who nominated/will nominate you? *

Do you have the ability to commute to Water Valley 5 days a week? *

Yes

Other:

Expected Graduation Date: *

YYYY

Clear form

Never submit passwords through Google Forms.

This form was created inside of Base Camp Coding Academy. Report Abuse

Forms