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Young Scholars Institute 2024 Registration
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* Indicates required question
Email
*
Your email
Student Last Name
*
Your answer
Student First Name
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Age (as of June 2024)
*
Your answer
Select which program you are completing registration for
*
Junior Scholars (must have completed 1st -4th grade)
Senior Scholars (must have completed 5th- 8th grade)
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
School
*
Your answer
Current Grade
*
1st (Junior Scholars)
2nd (Junior Scholars)
3rd (Junior Scholars)
4th (Junior Scholars)
5th (Senior Scholars)
6th (Senior Scholars)
7th (Senior Scholars)
8th (Senior Scholars)
Parent/ Guardian Name
*
Your answer
Parent/ Guardian Daytime Phone
*
Your answer
Parent/ Guardian Cell Phone
*
Your answer
Parent/ Guardian e-mail
*
Your answer
Parent/ Guardian Additional Contact Info
Your answer
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