2024 NxtGen Leadership Camp

Student Demographic Information

First Name*

Preferred Name (if different from above)

Middle Name

Last Name*

Birthdate*

Gender*

T-Shirt Size*

Student Contact Information

Student Email Address*

Mobile Phone*

Mailing Address*

Country

Street

City

Region

Postal Code

Additional Demographic Information (Optional)

The NxtGen Leadership Camp is an IYPC (Indiana Youth Programs on Campus) event funded by a grant from the Lilly Endowment. The IYPC grant is intended to develop programs that invite underserved students and families onto campuses where they can begin to envision themselves as future college students.

Answers to the following demographic questions are optional and will only be used for IYPC grant reporting and internal use at Manchester University.

Do you identify as Hispanic/Latino/Latinx?

Yes

No

What is your racial identity? (Hold [Ctrl] or [⌘] to select more than one.)

Are you a first-generation college student? *
Learn more here!

Yes

No

Academic Information

High School Name*

Anticipated College Start Term*

Top Academic Interest*

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Parent/Guardian Information
First Name Last Name Email Phone Number Relationship to Student Relationship to Student Father Mother Step-Father Step-Mother Legal Guardian Grandparent

Insert another parent/guardian.

Camp Information

*How did you find out about the Manchester University NxtGen Leadership Camp?