August 6 - August 20, 2015
Name:
/ / /Date of Birth:
/ / /Gender:
Address:
/ /City:
/ /State:
/Zip Code:
Home Phone:
/ /Cell Phone:
/Email Address:
/ /Intended Major:
/ /Will you be taking any college level courses for credit this summer? Y/N
Do you have a disability? If so, please explain.
Do you have any dietary needs or restrictions? If so, please explain.
Emergency Contact Information
Name: ______
Relationship: ______Phone Number: ______
This contract confirms your commitment to actively and fully participate in all components of the ACE Summer Institute. Please read and return by June 19, 2015.
Clark University
Office of Academic Advancement
950 Main Street
Worcester, MA 01610
By signing this contact you agree to abide by all of the following for the duration of the program:
1. No alcohol or illegal drugs.
2. To be in the residence hall by the hour required.
3. Fully participate in the scheduled academic and enrichment components of the program.
4. To remain on campus for the duration of the summer institute.
You are also expected to:
1. Participate in 6 leadership activities and workshops during the academic year.
2. Meet with faculty advisors and Graduate Assistant twice per semester and adhere to any academic plan developed during those meetings
3. Attend small group meetings and workshops during the Fall and Spring semesters.
By signing you are indicating you understand the attached descriptive profile of the ACE Summer Institute and agree to participate fully in the program. Furthermore, you agree to abide by the rules and conduct regulations while a participant in the program at Clark University.
This contract assures your on-campus room, board, and textbooks needed for the program.
______Signature Date
Participation is limited to 40 students. Enrollment is based on a first-come, first-serve basis.