NAKASEC Summer 2018: School of Change
Please fill out the form to the best of your ability.
The deadline to apply is June 18th, 11:59 pm.
Email address *
Name (Last, First) *
Your answer
Date of Birth *
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Address (Street, Apt #) *
Your answer
Address (City, State, Zipcode) *
Your answer
Phone Number (xxx) xxx-xxxx *
Your answer
If you are in college/high school, please indicate Rising Grade and name of institution *
Your answer
Emergency Contact (Name, Phone Number, Relationship) *
Your answer
Why do you want to participate in this program? (please answer in 150 words or less) *
Your answer
How would you describe your community? (please answer in 150 words or less) *
Your answer
Which social issue is important to you and why? (please answer in 150 words or less) *
Your answer
Are you willing to commit to all 5 weeks of the program? (If not, please provide exception/reason)
Do you have any dietary restrictions or allergies? Please list below
Your answer
Fun Question - If you had a pet, how do you think he/she/they would describe you? *
Your answer
How did you hear about "School of Change" and/or about NAKASEC? *
Your answer
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