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PGCC Cyber Smart 2024 - A GenCyber Camp (Middle School Application)
Middle School Camp Application Form - This camp is for Middle school GIRLS only. Rising 6-8th 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 have a letter of recommendation from a current teacher. Please make sure to include the name and email address of a current teacher. The teacher will be contacted to write a recommendation for you.
If a recommendation from a current teacher is NOT received, your application is incomplete.
Last Name
*
Your answer
First Name
*
Your answer
Gender (This camp is for Middle school GIRLS only)
*
Female
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
*
Youth medium (YM)
Youth Large (YL)
Youth Extra Large (YXL)
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 6-8 grade students only.
*
Choose
6
7
8
Middle School that you will be attending 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
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
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
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. If you do not have any allergies, write none.
Your answer
First and last name of a current teacher. This teacher will be contacted to complete a recommendation for you. Your application is incomplete and will NOT be considered if we do not receive a recommendation letter. This MUST be a CURRENT teacher.
*
Your answer
Email address of a CURRENT teacher for recommendation. This teacher will be contacted to complete a recommendation for you. Your application is incomplete and will NOT be considered if we do not receive a recommendation letter.
*
Your answer
A copy of your responses will be emailed to the address you provided.
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