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Student Information 
Please enter the student's first name
Please enter the student's middle name.
Please enter the student's last name
Please enter the student's mailing address
Please enter the student's mailing address city.
Please enter the student's mailing address zip code.
Please enter student's mailing address county.
Please enter the student's address.
Please enter the student's primary phone number.
Please enter the student's secondary phone number.
Please enter the student's date of birth.
Please select the student's gender.
Parent / Guardian Information 
Please enter the parent/guardian's first name.
Please enter the parent/guardian's last name.
Please describe the parent/guardian's relationship to the student.
Please enter the parent/guardian's mailing address
Please enter the parent/guardian's mailing address city.
Please enter the parent/guardian's mailing zip code.
Please enter the parent/guardian's mailing county.
Please enter the parent/guardian's email address.
Please enter the parent/guardian's primary phone number.
Dual Enrollment*
Indicate whether or not the student would like to be enrolled in dual enrollment. **Please note, dual enrollment decisions and options should be thoroughly discussed with high school counselor prior to application submission.
Dual Enrollment History *
Please indicate if the student has previously participated in dual enrollment.
School Information 
Please select the year that the student anticipates to graduate high school.
Please enter the name of the student's current school
Please enter the student's current school district.
Please enter the name of school official serving as the student's reference.
Please enter teacher / school official's position title (i.e. school counselor).
Please enter the email address of school official serving as the student's reference.
Please enter the phone number of school official serving as the student's reference.

Student Assurances

 I affirm, agree, and/or understand that all statements on this form are true and accurate; any misrepresentation or omission of material facts may result in disqualification or termination should I already be enrolled in the Manufacturing Technology Institute (MTI) Summer Camp.

 By making this application, I and my parent/guardian agree to the release of any necessary school records to the MTI Summer Camp and the respective university for the purpose of determining eligibility. I/we understand and agree that such school records will be kept confidential and used only for determining admissibility to the MTI Summer Camp. Students who do not agree to the release of such school records for determining admissibility will not be considered for the MTI Summer Camp.

 I certify to the best of my knowledge all of the information provided in this application is correct. I acknowledge that information about me may be used for publicity purposes if I am selected to attend a MTI Summer Camp.

Student Assurance*
Please review the student assurance above.

Parent/Guardian Assurances

 I have carefully reviewed the information on this application and give my permission for my son/daughter to proceed with application procedures. I acknowledge that the Manufacturing Technology Institute Summer Camp may offer university course credit and grades which will require university enrollment. I authorize the high school and its employees to release any information necessary for this application.

Parent/Guardian Assuances *
Please review the parent/guardian assurance above.

 
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