THE C.H.A.N.G.E MANTRA
THE C.H.A.N.G.E MANTRA
CAMP SOAR 2018
A C.H.A.N.G.E. Enterprise, Inc. Program
Program Application (July 15, 16, 17, & 18) Elizabeth City, NC
REGISTRATION DEADLINE: Friday, June 15, 2018
REGISTRATION FEE DEADLINE: Friday, June 29 2018
Registration Fee is $125.00 (may be paid via PayPal--Fees will Apply)
Payment may be sent via PayPal.com to firstname.lastname@example.org
Indicates required field
Grade for Upcoming 2018-2019 School Year (Rising Grade)
Please indicate your t-shirt size.
Parent's/Guardian's Phone Number
If you do not have an e-mail address, please input the following: email@example.com
Please list other activities student is involved in:
What is the best way to reach you (Check All that Apply)
Check All that Apply
(Family Member, Family Friend, Community Leader, etc)
Adult Recommendation can be a Family Member, Community Leader, etc.
Position/Relationship to student
Why do you recommend this student for this program?
Does the student display any behavioral issues that may present a challenge while working in a team environment during the workshop?
Yes, Please Explain Below
Please explain any behavioral issues here.
If the answer is no, please write N/A. If the answer is yes, please explain the behavioral issue(s) here.
What are some focus areas that woud benefit this student?
All Applicants Must Complete This Section
Please tell us your goals and any future careers you may be interested in:
List your hopes, dreams, desires, or even your summer or academic goals. We just want to know more about you!
I want to improve in the following areas. Check all that apply.
Decision Making/Problem Solving
Please tell us about yourself and why you are interested in the CAMP SOAR 2018 Summer Program.
We want to know more about you so we can tailor the workshop, so come on tell us a little about YOU!
PayPal payments are to firstname.lastname@example.org
Checks are payable to CHANGE Enterprises, Incorporated
Program Point of Contacts:
Dr. Jametta Davis, 703-899-0482
Shavonta Green-Floyd, 703-798-6303
Melba Smith, 252-335-3985
TO SUBMIT YOUR APPLICATION, PLEASE PRESS "SUBMIT" BUTTON BELOW.
If you make an error or need to amend the application, please e-mail us at
C.H.A.N.G.E. Enterprises, Incorporated
Alexandria, Va. 22309