2022 ExploreAg Registration Form
Fill out the form carefully for registration for the 2022 ExploreAg Camp Programs. Please note it will take 15 minutes to complete the application. The application will require you to name one professional reference with their contact information. The following essay question is required: Please outline one agricultural career you are interested in learning more about and why? (1,000 characters max). Please list not applicable if appropriate.
Student Name
*
First Name
Middle Name
Last Name
Birth Date
*
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February
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Year
Gender
*
Please Select
Male
Female
N/A
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student E-mail
*
example@example.com
Mobile Number
*
Are you Spanish, Hispanic, or Latino or none of these (select all that apply).
*
Spanish
Hispanic
Latino
None of these
Choose one or more races that you consider yourself to be:
*
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
White
Other
Prefer not to answer
What is the highest grade or level of school that you have completed?
*
Middle School (Grades 6-8)
Freshman (Grade 9)
Sophomore (Grade 10)
Junior (Grade 11)
Senior (Grade 12)
Name of Parents/Guardians
*
Address of Parent/Guardian
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email of Parent/Guardian
*
example@example.com
Phone Number of Parent/Guardian
*
Please enter a valid phone number.
Shirt Size
*
XS
Small
Medium
Large
X-Large
XX-Large
Please List Medical Conditions and Allergies
*
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My first ExploreAg Camp Session preference is ...
*
Weekend Camp- August 1-3 Hocking College
My second ExploreAg Camp Session preference is ...
Weekend Camp- August 1-3 Hocking College
What is your current GPA (4.0 Scale)?
*
Please List School-Related Honors, Recognition and Awards
*
Please List all Community Activities
*
Please List all Volunteer Activities
Please List all Leadership Experience
Name of Reference
*
First Name
Last Name
Phone Number of Reference
Please enter a valid phone number.
Email of Reference
*
example@example.com
Relationship to reference
*
Teacher
Advisor or Community Leader
Mentor
Other
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Essay Question: Please outline one agricultural career you are interested in learning more about and why?
*
0/1000
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Please leave any additional information that you would like us to know in the space provided below.
How did you hear about ExploreAg
*
Social Media
Teacher
Ohio 4-H
Ohio Farm Bureau
Other
Submit
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