Imagination Leads: HBCU Tour 2024 Application
Today's Date
Student's Name
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First Name
Last Name
Birthday
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Month
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Day
Year
Date
School Name
*
Grade
*
Gender
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Male
Female
Current GPA
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Student Email
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Student Phone Number
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Parent/Guardian's Name
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First Name
Last Name
Parent/Guardian's Email
*
example@example.com
Parent/Guardian's Phone Number
*
Please enter a valid phone number.
In 100 words or less, why would you like to participate in the HBCU tour?
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Shirt size
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small
medium
large
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By signing this form, I understand that I am responsible for a non refundable $35 participation fee to be paid within 48 hours upon notice of acceptance.
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