HBCU Night's 'A DiGiTAL WORLD' Registration

A DiGiTAL WORLD Registration Form (Fall '23)

Please fill out the form carefully
Your Name:

First NameMiddle InitialLast Name
Name of Parent/Guardian:

First NameMiddle InitialLast Name
Birth Date:

DayMonthYear
Gender:
Are you at least 14+ years of age? (If not, you will NOT be able to complete this form and a parent or guardian must email management@hbcunight.org separately to request attendance. Parent or guardian must be in attendance with any scholar under the age of 14):
Age:
E-mail to share with HBCU recruiters:
example@example.com
E-mail of Parent/Guardian:
example@example.com
Phone # to share with HBCU recruiters:
Please enter a valid phone number.Format: 0000000000.
Phone Number of Parent/Guardian:
Please enter a valid phone number.Format: 0000000000.
Hometown/City, State:
Current High School or Community College:
High School or Community College Graduation Class:
Classification:
Grade Point Average (GPA from most recent semester/marking period going into Fall '23):
Test Score:
Test Type:
List all HBCUs you are interested in applying to:
Extra Club/Organization/Curricular/Community/Leadership Experience to share with HBCU recruiters:
Instagram Handle (@ on social media):
Twitter Handle (@ on social media):
Why an HBCU?
What is your desired profession after you graduate college?
Areas of study you are interested in

Other
Are you interested in our Scholarship Talks Sessions/Scholarships?
Are you interested in a follow-up for our Scholarship Success Stories in May-June '24? (Scholar/Parent/Guardian must sign parent agreements to participate be featured in top media outlets)
Are you interested in a chance to win a laptop as a top HBCU Night Scholar?

A DiGiTAL WORLD Registration Form (Fall '23)