Roots of Knowledge Empowerment Institute 2016 Application
June 13-17th at Sherman Oaks Center for Enriched Studies (SOCES)
Applicant's Full Name *
First, Middle, Last
Your answer
Address *
Number, City, State, Zip
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Name of Parent(s)/Guardian(s) *
Your answer
Parent/Guardian Primary Telephone Contact # *
(xxx-xxx-xxxx)
Your answer
Parent/Guardian Primary Email Contact Address *
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Applicant's Birth Date *
(MM/DD/YYYY)
Your answer
Applicant's Gender *
Your answer
Applicant's School Name *
Your answer
Applicant's School Telephone *
(xxx-xxx-xxxx)
Your answer
What grade will the applicant begin in the fall of 2016?
Your answer
List the title of a book that the applicant has read in the course of the last school year *
Students in the institute will be expected to read 25-30 pages per night and be able to write a five-paragraph essay
Your answer
Applicant's Tennis Skill Level *
What do you expect to gain from attending this institute *
This question should be answered by the applicant
Your answer
Does the applicant require any physical accommodations? *
Please use the space below to explain a YES answer to the previous question
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Does the applicant have any allergies? *
Please use the space below to explain a YES answer to the previous question
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