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Central Honors Institute Application

Register for CHI below
  • Central Honors Institute Application Form

    Please complete and submit by May 1, 2018

    Don't forget to have your teacher and counselor/school official fill out the school forms.


    Applicant Information

     
    Name:  
    Mailing Address:  
    City
    Zip Code
    Date of Birth:    [None] Select a Date Delete the Date 
    Grade (in fall 2017):  
                 
    Gender:  
                 
    SSN or CCC ID:  
    Name of school (fall 2017):  
    Home phone:  
    E-mail address:  
    Did you attend CHI last year?  
                 
    Applicant’s T-shirt size:  
    Name for CHI nametag, if different than above:  
    My CHI Track Preference:  1st Choice

    2nd Choice

    3rd Choice 

    Parent/Guardian Information 

     
    Mother/Female Guardian Name: 
    Day phone: 
    E-mail address: 
    Mailing address:
    (if different from applicant’s) 
    Father/Male Guardian Name: 
    Day phone: 
    E-mail address: 
    Mailing address:
    (if different from applicant’s) 
    Is either parent a full-time employee of Central Community College?
                                         
    Signature of Parent of Legal Guardian:

    *By typing your name you give your child permission to apply for the CHI Academic Camp.