Please complete the following form totally in order to apply.

Name of Applicant:

Applicant's Home Phone:

Applicant's Cell Phone:

Applicant's Email:

Applicant's Age:

Grade entering in Fall, 2007 11 (Junior) 12 (Senior)

High School:

Do You Plan to Attend a Georgia College? Yes No

Name of Parent/Legal Guardian:

Address:

City: State: Zip:

Parent's Day Phone:

Parent's Evening Phone:

Parent's Email:

Briefly describe why you want to attend the workshop and what you would like to accomplish.

What is the highest level math class you have completed?*
* Needed for preparing materials for workshop; workshop is not math-intensive.