Communication for Youth Application

Please complete and submit the application. Incomplete applications will not be accepted.

By submitting this application, applicant understands and agrees to the following:

Space is limited and priority will be given to first time participants. The Communication for Youth team will contact you to confirm enrollment. Only when enrollment is confirmed will you receive information regarding class location and session information. If you do not receive a confirmation email, this means your child was placed on a waiting list and Communication for Youth will contact you in the event a seat becomes available. No new registrations will be accepted on the first day of class. All information provided may be verified.

Last Name *

First Name *

Date of Birth *

Grade *

School *

Sex *

Street Address *

City *

Zip *

State *

Apt #

Preferred EMAIL Address *

Home Phone

Work Phone

Cell Phone

Parent/Guardian Name *

Parent/Guardian Address *

Parent/Guardian City *

Parent/Guardian Zip *

First Time Attendant *

Referred By

I hereby certify that the information in this application is true and correct, and I authorize the Communication for Youth team to verify the information on this application form. I understand that this program is free of cost and that this application does not confirm enrollment. (*NOTE-All online completed registration forms will need a confirmed signature from parents when youth attends the program.)

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Mike Curb College of Arts, Media, and Communication

Department of Communication Studies

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Communication for Youth Application