Hollinsummer Application

Session I: rising 7th and 8th graders
Session II: rising 9th through 12th graders

* indicates a required field

Student Information:

Full name: *

Preferred name:

Home address: *

Mailing address: *

E-mail address:

Daytime telephone: *

Student’s cell phone:

Middle School or High School: *

Grade you will be entering in the fall of 2010: *

High school graduation
date: *

Please indicate your top four course choices. You will be enrolled in two of the four courses you select, depending on course availability. Only applicants who submit a $100 deposit will be considered for class placement.

Courses:

For middle school and high school students:

Creative Writing
Exploring Pottery
Leadership for Results
Modern Dance
So You Want to be President Someday?
Painting

For high school students only:

Explorations in Forensic Chemistry
Exploring Digital Storytelling
The Global Gastronomer: A Trek Around the World’s Cuisines
Photography
Psychology: The Human Mind
Video Production

First choice:

Second choice:

Third choice:

Fourth choice:

Please indicate your top three choices. You will be enrolled in one.

Athletic Clinics/Outdoor Program:

Basketball
Golf
Lacrosse
Rock climbing
Soccer
Swimming
Tennis
Volleyball

First choice:

Second choice:

Third choice:

How did you hear about Hollinsummer? *

How to pay your $100 deposit to secure your place.

	I will phone the Admissions Office (800-456-9595) with my credit card information.
	I will mail my check made payable to ''Hollinsummer'' to:
	Hollinsummer Program Hollins University P. O. Box 9707 Roanoke, VA 24020

Parent or Guardian Information:

Parent or legal guardian: *

Father's daytime
telephone: *

Father's cell phone:

Father's e-mail address:

Mother's daytime
telephone: *

Mother's cell phone:

Mother's e-mail address:

What are your reasons for wanting to attend the Hollinsummer program? *