Central Honors Institute Application

Student's Legal Name

Name for CHI nametag

Mailing Address

City

State

Zip Code

Date of Birth

Grade (in fall 2022) 7th 8th

Gender Male Female Non-binary

Name of school (fall 2022)

Home phone

Email

Applicant's T-Shirt Size

My CHI Track Preference: 1st Choice

2nd Choice

3rd Choice

Parent/Guardian 1 Name

Parent/Guardian 1 Phone (if different from applicant's)

Parent/Guardian 1 Email (if different from applicant's)

Parent/Guardian 1 Mailing Address (if different from applicant’s)

Parent/Guardian 2 Name

Parent/Guardian 2 Phone (if different from applicant’s)

Parent/Guardian 2 Email (if different from applicant’s)

Parent/Guardian 2 Mailing Address (if different from applicant’s)

Is either parent a full-time employee of Central Community College? Yes No

Permission I, the legal parent/guardian, give my child permission to apply for the CHI Academic Camp