SCIENCE IN THE SUMMER AT ESPERANZA
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Name of Parent:
*
First Name
Last Name
Name of Student
*
First Name
Last Name
Email Address:
*
Email
Mobile Number:
*
Format: (000) 000-0000.
Secondary Number:
Format: (000) 000-0000.
Student's Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of school for Fall 2026:
What grade will the student attend in Fall 2026?
*
Please Select
2nd Grade Student
3rd Grade Student
4th Grade Student
5th Grade Student
6th Grade Student
Race/Ethnicity
White
Black
Latino
Asian
Other
Gender
Male
Female
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How did you hear about Esperanza College?
College Fair
Our Website
Social Media
ECEU Student
Dual Enrollment or Early College
Other
PARENTAL CONSENT: My signature serves as my approval for my child to participate in the Science in the Summer program at Esperanza College. I also give my consent to obtain emergency medical and or dental care for the Student if such attention is required at any time when I am unavailable for contact at the numbers listed above.I understand that the camp will be held onsite at Esperanza College located at 4261 N 5th street, Philadelphia, PA 19140.
Submit
Esperanza College of Eastern University
4261 N. 5th Street
Philadelphia, PA 19140
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