2013 College Kids Application- OPEN

Theme:Academics
Registration Deadline: September 16, 2013
Program Date: October 5, 2013, 9:00 a.m. to 4:30 p.m.
Location: Indiana University - Memorial Union Tree Suites

Registration Options
  • Fax: 812-856-0445
  • Mail: Office of Community & School Partnerships
    1900 East 10th Street
    Eigenmann Hall Room 617
    Bloomington, IN 47406
    Application: 2013 College Kids
  • Register Online
  • For more information, please contact Kim Morris-Newson kmorrisn@indiana.edu 812-856-6003
  • IUB Disability information listed

Participant Information



First Name of applicant:
Last Name:

Street address:
City:    State:   Zip code:
Phone number:   Age:
Gender: Male Female
Ethnicity:

School Name:
Current Grade:
Please list any special needs: Please list any physical limitations that may challenge or hinder your
participaton in indoor or outdoor activities:
If you are in need of disability services while on campus, please contact
Indiana University Disability Services at (812)855-7578 or iubdss@indiana.edu.
Please list any Disability:
Please list any allergies:


T-Shirt Size:

Small
Medium
Large
X-Large
XX-Large
XXX-Large

Pizza Preference:

Parent or Guardian Information



First Name: Last Name:
Email Address:
Home Phone: Cell Phone:
Date: