Submit the completed registration form

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Session Information

Which Global Scholars Academy session are you interested in?**

Session 1 (In-Person): July 11-14| High School
Session 2 (In-Person): July 18-21 | High School
Session 3 (In-Person): July 25-29 | High School

Student Information

Student Name:*

First Last

Date of Birth:*

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student Email:*

Student Phone:*

Preferred Method of Communication:*

Phone
Email

Parent/Guardian Name:*

First Last

Relationship to Student:*

Parent/Guardian Email:*

Parent/Guardian Phone Number:*

Preferred Method of Communication:*

Phone
Email

School Information

Name of Student's School:*

Grade Attending in Fall 2022*

Additional Information

Essay

Essay: In 500 characters or less, please explain, what are three key challenges facing our world today and why are they important? Please take note of your statement’s quality, thoughtfulness, grammar, and spelling.*

If your response requires more characters, please feel free to attach below.

File

Max. file size: 50 MB.

Medical Information

Medical History / Allergies*

Please list any of your child's health issues of which we should be aware (i.e. allergies, limitations, etc.). Please enter "N/A" if there are none.

Physician Name:*

First Last

Physician Telephone Number:*

Primary Emergency Contact:*

First Last

Primary Emergency Contact:*

First Last

Relationship to Applicant:*

Primary Emergency Contact Telephone Number:*

Primary Emergency Contact Email Address:*

Secondary Emergency Contact:*

First Last

Relationship to Applicant:*

Secondary Emergency Contact Telephone Number:*

Secondary Emergency Contact Email Address:*

Privacy Statement and Signature

All personal data collected through this program will be utilized for the World Affairs Council of Greater Houston Global Scholar Academy and Educational Programs purposes only. By submitting this form and checking the box below, you certify that you have provided correct biographical information.

Consent*

I agree to the privacy policy.

Consent*

I have completed this application fully and accurately to the best of my knowledge.

Student Signature:*

First Last

Parent/Guardian Signature:*

First Last

Global Scholars Academy Application (2022)

Session Information

Student Information

School Information

Additional Information

Essay

Medical Information

Privacy Statement and Signature