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LEAD Appalachia Roommate Assignment Form
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Submit forms with registration to complete application.
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2-4 students may be assigned per room. Chaperones may be assigned 1-2 per room, or in a room with a blood relative student.
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Chaperone NameOrganization NameCountyChaperone phoneChaperone email
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Emma FilipkowskiBoys & Girls Clubs of SENCNew Hanover315-939-3109efilipkowski@bgcsenc.org
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Room (add rooms as appropriate) Indicate with an (*) any room with adultsName 1Name 2Name 3 (optional)Name 4 (optional)Special Needs & Requests
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1Chastity Hall-ConyersKenyetta Briley
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2Zariyah FairAnivea Willis
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3Cesia Barrios MartinezSa’nia FreemanPamela Farrior
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