Golden Bear Pharmacy Summer Camp - Junior and Senior Application 2023

Monday, June 26th, 2023 - Friday, June 30th, 2023

Western New England University - CSP 400
1215 Wilbraham Rd
Springfield, MA 01119

In the spaces provided below, please enter the following information about YOURSELF:

First Name*

Last Name*

Birthdate*

Mobile Phone*

Email Address*

Gender*

Race/Ethnicity. Check all that apply.*

Mailing Address

Country

Street

City

Region

Postal Code

Citizenship*

High School*

School CEEB Code

What grade will you be entering in the Fall of 2023?

Please indicate your anticipated college entry term

Time Status

Academic Interest

Have you ever been on a waiting list for this camp?

Unisex Adult T-Shirt Size

In the space provided below, please describe your motivation for applying to the Golden Bear Pharmacy Summer Camp for High School Students as it relates to your future goals and career aspirations (limit 500 words/3500 characters).

In the spaces provided below, please enter the following information about your PARENT or GUARDIAN:

First Name*

Last Name*

Email Address*

Best Number to reach Parent/Guardian*