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PGCC Cyber Smart 2024 - A GenCyber Camp (High School Application)
High School Camp Application Form - This camp is for high school boys and girls. Rising 9th - 12th graders.
NOTE: This camp will be held at the Largo campus of Prince George's Community College.
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Email
*
Your email
Instructions
Please complete the form below. In addition to this form, you MUST include a short essay (minimum 200 words) explaining why you will like to participate in a cybersecurity camp. This should be submitted with the application in the appropriate section of this form.
Last Name
*
Your answer
First Name
*
Your answer
Gender
*
Female
Male
Other:
Race
*
Black or African American
White
Asian
American Indian
Native Hawaiian or other Pacific Islander
Other:
Ethnicity
*
Hispanic or Latino
Not Hispanic or Latino
Age
*
Your answer
T-shirt size
*
Adult Small (S)
Adult Medium (M)
Adult Large (L)
Adult Extra Large (XL)
Adult XXL (XXL)
Other:
Grade in 2024/25 school year. This camp is for rising 9-12 grade students.
*
Choose
9
10
11
12
High school you will be attending in 2024/25 school year if not known include current school.
*
Your answer
ADA accommodations needed
(If a student requires any academic support or has an IEP, 504, or BIP, please indicate below. It is very important that we are aware of student’s needs to adequately support them.)
Your answer
Home Address
(This address will be used to mail any resources needed for camp, if needed. Please ensure correct address)
*
Your answer
Student email
This is optional. Please include if you want to be on the email list.
Your answer
Have you attended any previous GenCyber camp?
*
Yes
No
If you answered yes to the last question, please state the name of the school where you attended the GenCyber camp.
Your answer
Parent/Guardian's names
*
Your answer
Parent/Guardian's cellphone number
*
Please include the best contact numbers for you.
Your answer
Parent/Guardian's email
*
Please include a valid email address. This is the primary way to contact you.
Your answer
Annual Family Income (Note: Preference is given to low income students)
*
Below $50,000 per year
$50,000 - $75,000 per year
$75,000 - $100,000 per year
Above $100,000 per year
Emergency contact name (Other than parents)
*
Your answer
Emergency Number (Other than parents)
*
Your answer
List any health concerns that we need to know about
Your answer
Food Allergy.
Please list all known food allergies.
Your answer
Why do you want to participate in a Cybersecurity camp? (Minimum 200 words)
*
Your answer
A copy of your responses will be emailed to the address you provided.
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