Camp REACH Application Form

Camp REACH Application Form

One week. Big growth. Real results. Camp REACH is an immersive college and career readiness experience designed to prepare students for high school success—and ultimately college acceptance. Scholars from across Memphis and surrounding communities dive into high-energy workshops, interactive challenges, and team-based experiences focused on leadership development, résumé building, interview skills, academic planning, and navigating the college admissions process with confidence.This isn’t just a camp—it’s a fun, fast-paced launchpad where students build friendships, discover their strengths, and step boldly toward becoming confident, college-bound leaders.
Student Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*
Other
Race/Ethnicity *
Other
Student Email Address*
example@example.com
Student Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Current Grade*
What is your high school name and school district?*
What is your current G.P.A?*
Are you First-Generation College student?*
What are your academic interests?*
What are you career interests?*
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name (if different from parent/guardian)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Please list any allergies, medical conditions, or special needs*
Please list any dietary restrictions. *
What do you hope to learn/gain from Camp REACH?
How did you hear about Camp REACH?*
Please write the name of the person that refer you to Camp REACH.
YesNo

Camp REACH Registration Fee*

Camp REACH Registration Fee

$375.00

Enter coupon

Total

$0.00

If you have any issues with the first three payment options, please select the fourth option, “PayPal Credit Checkout.” Then choose “Pay with Credit or Debit Card” without logging into PayPal. This will allow you to complete your payment without creating a PayPal account.

If you run into any problems, please contact us at info@reachmemphis.org or 901‑682‑0699.
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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