DREAM Alive HBCU Trip
DREAM Alive will take 30 students on a 3-day, 2-night trip to different Historical Black Colleges and Universities (HBCU) in the Nashville, TN area. The colleges we'll be visiting are Tennessee State University, Fisk University, American Baptist College, and MeHarry Medical College. The trip will be on October 13-15, 2025. To lock in your spot for the trip, you must complete this application form, have a SIGNED HS Waiver Form, AND turn in $20 to a DA staff member. If you have any questions, please contact our High School Development Director, Andy Conrad, at 812-350-6469.
Name
First Name
Last Name
Scholar Email
PLEASE put a personal email address and not your school email address.
Scholar Cell Number
What organization are you with?
Please Select
DREAM Alive Inc.
Elevate
Shepherd
Grade Level
9th Grade
10th Grade
11th Grade
12th Grade
Gender
Please Select
Male
Female
Prefer not to say
Type a question
Please Select
High School Attending
Arsenal Tech High School
Shortridge High School
Crispus Attucks
Purdue Poly Tech
George Washington High School
Herron High School
Warren Central High School
Other
T-Shirt Size
Please Select
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Any Food Allergies or Diet Restrictions
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Emergency Contact Information
Emergency Contact Name
First Name
Last Name
Emergency Contact Email
example@example.com
Emergency Contact Number
Please enter a valid phone number.
I plan to pay the $20 Application Fee....
Cash (Give to Staff)
Online Credit Card Payment
Pay Application Fee
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( X )
USD
Description
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
What is your career field interest?
Please Select
Engineering/Architecture
Medical
Education
Physical Therapist
Performing Arts
Graphic Design
Business (Management/Marketing)
Real Estate
Computer and Technology Engineer
Accountant
Workforce
Trade School
Military
N/A
If you didn't see your career field choice on the drop-down menu, write out what career opportunity you want to pursue after high school.
You don't have to put "I want to attend college" but write out what career choice you would like to pursue.
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Please indicate of any medical conditions and/or medications of the student that DREAM Alive staff should be aware of:
I give permission for DREAM Alive staff to distribute any necessary over-the-counter medicine and my student's prescription medicine. (Parent/Guardian signature is needed)
Submit
Should be Empty: