2023 Summer Bridge Program Application

Parent / Guardian Information

If the registering student is under 18, parent contact information and consent is required.
Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Address below is:

Same as student's addressDifferent address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Photo and Video Release Form

As part of the bridge program, NOVA photographers may visit the classroom to document student activities for the purpose of promotion and evaluation.
Participants above 18 years old: By registering for the IET summer bridge program, I hereby give the right to take, use, and publish, display, broadcast, or print – in any media – photographs, slides, digital images, films, and audio or video recordings made in conjunction with this project, to the full extent in which I am included. I also give permission to Northern Virginia Community College (NOVA) to use my name and biographical information. I understand that such sounds, images, and personal information may be used for instruction, promotion, advertising, and any other lawful purpose. I further certify that I am over 18 years of age.*

YesNo
Student: I agree to provide an electronic signature to document my consent.*

YesNo
First NameLast Name
Clear
MonthDayYear
Parent or Guardian for participants below 18 years old: By registering for in the IET summer bridge program, I hereby give the right to take, use, and publish, display, broadcast, or print – in any media – photographs, slides, digital images, films, and audio or video recordings of my child made in conjunction with this project, to the full extent in which they are included. I also give permission to Northern Virginia Community College (NOVA) to use my child’s name and biographical information. I understand that such sounds, images, and personal information may be used for instruction, promotion, advertising, and any other lawful purpose.*

YesNoStudent is 18+
Parent Guardian Name *

First NameLast Name
Parent or Guardian Signature*

Clear
Date Signed

MonthDayYear
Date

NOVA Bridge Program Application

Student Demographic Information

Parent / Guardian Information

Photo and Video Release Form

Consent Form

Student Assent

Parent or Guardian Consent