Greater Than Math Application for Middle School Students
2022 Summer Camp | June 27-July 15, 2022 . @ Case Western Reserve University Extension: Application due by 5:00 pm on May 6, 2022
Student Information
Name
First Name
Middle Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birth Date
-
Month
-
Day
Year
Date
Gender
Male
Female
Other
Race/Ethnicity
Multiple/Greater Than One
Black
White
Hispanic
Asian
American Indian
Hawaiian/Pacific Islander
Other
What school do you currently attend?
In what grade are you currently enrolled (in the spring of 2022)?
6th
Please attach a copy of your most recent report card here (a picture is acceptable).
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Do you have any allergies, dietary restrictions, medical conditions, or other needs of which we should be aware? If so, please describe here:
Parent/Guardian Information
Parent/Guardian #1
First Name
Middle Name
Last Name
Parent/Guardian #1's Relationship to Student
Parent/Guardian #1's Email
example@example.com
Parent/Guardian #1's Phone Number
Please enter a valid phone number.
Parent/Guardian #2
First Name
Middle Name
Last Name
Parent/Guardian #2's Relationship to Student
Parent/Guardian #2's Email
example@example.com
Parent/Guardian #2's Phone Number
Please enter a valid phone number.
Parent/Guardian #3
First Name
Middle Name
Last Name
Parent/Guardian #3's Relationship to Student
Parent/Guardian #3's Email
example@example.com
Parent/Guardian #3's Phone Number
Please enter a valid phone number.
Who should be contacted in the case of an emergency? Parent/Guardian 1, 2, or 3 above, or someone else? If someone else, please list their name, phone number and email.
Essay
Why would you like to join the Greater Than Math team this summer? Please write at least 100 words.
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