FREE ACT CAMP!

William Carey University School of Education

ACT Camp Scholarship Application (risingSeniors and Juniors only) -Summer 2018

Choose a location:

______May 29, 2018 – June 1, 2018 – Tradition Campus (Biloxi) 8:30 am – 3:30 pm

______June 4-8, 2018 – Hattiesburg Campus (NR Burger Middle School) 8:30am-3:30 pm

Application deadline: Postmark or hand deliver by April 5, 2018, 5:00 PM

Instructions: This application must be completed legibly in its entirety, signed by parent or guardian, by school counselor or principal, and by the student. Incomplete and late applications will not be considered.

Name: ______

First Name Middle InitialLast Name

Preferred Name for name tag: ______Date of Birth: ______Gender:__MALE __FEMALE

Are you a member of a Teacher Academy? _____YES _____NO (If yes, ____year one ____ year two ___ Year three)

Parent Name: ______

Parentemail Address: ______

ParentMobile Phone: ______Parent Home Phone______

Street Address: ______City: ______Zip: ______

High School Name:______Graduation year:______

Have you ever taken the ACT test? __YES __NO If yes, what is the highest composite score you have achieved? ______

I understand that if I am acceptedI must show proof of registration for the June 9, 2018national exam by May 20, 2018or my seat at this camp will be forfeited. I will have scores sent to WCU. ______(parent initials)

Are you already registered for the ACT test to be given on June 9, 2018(no other date is acceptable)? ___YES ___ NO (If yes, attach confirmation)

I understand that I am expected to attend this camp in its entirety if I am accepted. ______(student initials)

By my signature below, I would like to recommend this student as a potential candidate for this camp because:

___he/she has initiative but is in need of a passing ACT score to complete requirements for high schoolgraduation.

___he/she has shown initiative as a student interested in attending college(Current GPA ______).

Signature______

CHECK ONE: _____School Counselor / _____School PrincipalPhone number

(Complete page 2 on reverse side)

By signing below, I approve of my child attending the WCU ACT Camp under scholarship and will help in any way necessary to insure that they attend the camp in its entirety.

______

Parent or Guardian SignatureDate

Please tell us how you knew about this camp:

______Counselor or Teacher ______Teacher Academy ______Friend ______Newspaper, Radio or TV

______Other ______

I would like to be considered for this camp scholarship and I am committed to do what it takes to raise my ACT score for high school graduation or college acceptance purposes. If I find that I cannot attend the camp in its entirety, I will immediately relinquish my seat giving someone else an opportunity to utilize this camp.

______

Student signature

______

Date

Return all applications to:

William Carey University

School of Education, Box 3

710 William Carey Parkway

Hattiesburg, MS 39401

ATTENTION: Tina Bond

Note: No email or fax copies will be accepted. US Postmark will be used to determine application date, not delivery date.

Applicants that are accepted will be notified by May 1, 2018 via parent email.

This application is open to risinghigh school Seniors and Juniors only.

Students are only accepted once to WCU ACT Camp.