GANAS Application Form

Application to attend GANAS Edúcate Summer Symposium.Application Deadline: June 3rd, 2022

Sunday June 26th- Wednesday June 29th, 2022

Application Form
(Please note that fields marked with an (*) are required.)

Name (First and Last):*

Birthday (MM/DD/YYYY):*

Home or Mailing Address:*

City:*

State:*

ZIP Code:*

Home Phone:

Cell Phone:

Email:*

Languages you speak (fluently or not):

Language(s) primarily spoken in your home:

Parents/guardians who will drop you off or pick you up after program & phone number:*

Name of school you are attending:*

Current grade level in school:*

Year you expect to graduate from High School:*

T-shirt Size:

X-Large

Large

Medium

Small

Returning GANAS Student:

Yes

Why do you want to attend COCC’s GANAS program?

Please describe what your future goals are in detail:

Please discuss what things you are currently doing at your High school and/or community?

For returning GANAS student. Why do you want to return to GANAS?