2017 STEP TO THE FUTURE SPRING BREAK COLLEGE TOUR REGISTRATION
Student Name
First Name, Last Name
Your answer
Gender
Address
Street, City, State, ZIP
Your answer
Home Phone
Area code + 7 digit number
Your answer
Cell Phone
Area code + 7 digit number
Your answer
E-mail Address
Your answer
Date of Birth
(mm/dd/yyyy)
Your answer
Ethnic Background
Check all that apply
Are there any languages, other than English, spoken at home?
If so, what language(s)?
Your answer
Are you enrolled in an ESL program?
What language does your family prefer?
Your answer
Name of School
Your answer
Grade Level
Your answer
What types of careers interest you?
Your answer
Do you plan on attending college after you graduate?
If yes, what do you plan on majoring in?
Your answer
STUDENT'S PLEDGE
As a condition of my travel on the 2017 Step to the Future Spring Break College Tour, I hereby pledge to follow the code of conduct established by the group, including those concerning my behavior and respect for all leaders, coordinators, chaperones, peers, and any others that assist or support the group’s activities before, during, and after the tour. I also understand that violation of the code of conduct could result in my being prevented from participating in certain tour activities.
Student Signature
First Name, Last Name
Your answer
Date Signed
MM
/
DD
/
YYYY
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