Registration 2019

Camper Information

First Name

Last Name

Nickname

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Camper Education Information

School Name

Grade you will enter in the Fall of 2019

Parent Guardian Info

Guardian First Name

Guardian Last Name

Is parent/guardian address same as camper's

Yes

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Guardian Phone

Guardian Email

Does an immediate family member/guardian work for the University of Illinois

Yes

Name

Why are you interested in participating in the Pollen Power! Camp

Learn about science

Interest in climate change

Use microscopes

How did you hear about Pollen Power! Camp?

Are you interested in a scholarship

Yes

Are you a Tap In Scholar?

Yes

Is the camper applicant part of an underrepresented population?

Yes

If yes, then which population? (Optional)

Does the applicant qualify for a federal free or reduced lunch?

Yes

For QUESTIONS OR MORE INFORMATION ON POLLEN POWER SUMMER CAMP, PLEASE CONTACT:

Adrienne Gulley
Camp Coordinator
pollenpower@igb.illinois.edu
217-300-6170