Student Referral Application

Submission of this form does not guarantee registration for the event. Applications will be reviewed for selection of students, and teachers or homeschool parents will be notified at least two weeks prior to the event.

Participation is limited to North Dakota students.

Student Details

First Name^*

Last Name^*

Age^*

Grade Level^* Please SelectSophomoreJuniorSenior

School Name^*

School City / Town^*

County^*

Referring Teacher or Homeschool Parent

First Name^*

Last Name^*

Position

Address^*

City^*

State^* Please SelectND

Zip^*

Phone^*

Email^*

Referral Details

Student Interests/extra-curricular activities/hobbies

Student career plans (if known)

Tell us anything else about the student that you think we should consider in our selection process for this event