Lehigh Valley Overnight November 18 trip

Lehigh Area Overnight Trip

Date: November 18-19th
Join us to tour Northampton Community College, Lehigh University, Moravian College and Lehigh Carbon Community College.

Open to students in 10th, 11th & 12th grade from Scranton Area, Wilkes Barre Area, Hanover, Hazelton Area and Shenandoah Valley High School.

Pick ups at Scranton High School, Wilkes Barre Area & Hazelton Area.

Submission of this form does not guarantee a space on the trip. You will be contacted by an EOC Academic Specialist to confirm your seat prior to the trip.

Please contact Frannie at Frannie@eocince.org or 5704011173
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail*
example@example.com
Mobile Number*
Format: (000) 000-0000.
10th Grade11th Grade12th Grade
ScrantonWilkes Barre areaHazeltonShenandoah ValleyHanover
I am interested in a Degree they have at that schoolI just like Talent Search Field TripsI may want to go to school in that area
Potential Roommate Choice
Please read the attached 'Informed Consent and Assumption of Risk' form
Student Signature: I understand that this is long day field trip and that I must respect social distancing and follow Covid Rules such as mask wearing when required. My signature indicates that I have read, understood and agree to the attached 'Informed Consent and Assumption of Risk' form.*

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Parent/Guardian Name*

First NameLast Name
Parent or Guardian Phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent Email Address*
example@example.com
MiddleHigh SchoolGEDAssociates DegreeBachelor DegreeMaster Degree
MiddleHigh SchoolGEDAssociates DegreeBachelor DegreeMaster Degree
1-21,8702-29,5803-37,2904-45,0005-52,7106-60,4207-68,1308-75,840
AboveBelow
Parent Permission and Signature: My signature indicates that I have read, understood and agree to the attached 'Informed Consent and Assumption of Risk' form.*

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Lehigh Area Overnight Trip