ENHE Student Application
2019 Summer Program
Student Name *
Your answer
Student Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Male/Female *
School 2018-2019 *
Your answer
Grade (for 2018-2019 school year) *
Teacher
Your answer
Parent/Caregiver's Name (s) *
Your answer
Street Address *
Your answer
Mailing Address, if different
Your answer
Home Phone Number *
Enter with dashes: 123-456-7890
Your answer
Cell Phone Number *
Enter with dashes: 123-456-7890
Your answer
Work Phone Number
Enter with dashes: 123-456-7890
Your answer
Occasionally, we may communicate with you by text or email, if that is okay with you.
May we text you? *
May we email you? *
If yes, please provide preferred phone number and/or email:
Your answer
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