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HSDA SUMMIT 2024 REGISTRATION FORM

HSDA Summit 2024 Registration

Graduation Year

Not in the US?

How long have you been a member of HSDA? Less than 1 year 1 year 2 years 3 years 4 years

Are you part of a local HSDA chapter? * Yes, a school chapter Yes, a community chapter Yes, but I'm not sure what type of chapter No, I'm not part of a local chapter

Select as many caucuses that apply AANHPI Caucus Black Caucus Disabled Persons Caucus First Generation Caucus Hindu Caucus Jewish Caucus Latinx Caucus LGBTQ+ Caucus Middle East and North Africa (MENA) Caucus Muslim Caucus Women’s Caucus Indigenous Peoples Caucus

PARENT: First and Last Name *

PARENT: Email Address *

PARENT: Phone # *

PARENT: Do you understand that the full $525 tuition payment (plus any processing fees) for Summit is due June 18th, 2024? * Yes

PARENT: Has your student applied for a need-based scholarship? The scholarship application form can be found on the HSDA Summit website. * Yes (by registering, I understand that I must pay the full tuition for Summit if not granted a scholarship). No

PARENT: Do you understand that any expenses incurred while travelling to and from Summit (and any student expenses outside of pre-planned Summit programming) are NOT covered in the tuition price? * Yes

PARENT: Do you understand that, while we will take measures to prioritize safety above all else, HSDA is not liable for any accidents, damage, or any other harm to students or student property? * Yes

PARENT: Are you interested in being a mentor/chaperone at Summit? * Yes No Maybe, send me information

STUDENT SIGNATURE: *

PARENT SIGNATURE: *

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