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College Prep Institute

Info

Jr. Self-Discovery/Career Exploration

A program for 4th-6th graders

Find out more or register below

Registration Deadline: July 13, 2012
MANDATORY Orientation: July 19, 2012
Registration Fee: $25

Class Sessions: Saturdays August 4 - September 22, 2012

ATTENDANCE MANDATORY at orientation and 1st session

Student's First Name ■

M.I.

Student's Last Name ■

Gender ■

Female
Male

Parent/Guardian First & Last Name ■

Sarah Hill

Parent/Guardian E-mail Address ■

Address, Apt #, City, State, Zip Code ■

2011 Up Hill Rd. Apt. B Indianapolis, IN 46555

Home Phone ■

317-123-4567

Work Phone

317-123-4567

Cell Phone ■

317-123-4567

How did you hear about CLD? ■

TV/Radio Commercial

My School

A Parent

Indiana Black Expo

HBCU College Fair

IBJ

Indianapolis Recorder

Other

Please choose the class time of choice: ■

Current School: ■

Career Goal:

Grade in School (Fall 2012): ■

How would you like to pay the registration fee? ■

I understand that by participating in CLD programs I am giving permission to be photographed and recorded for the purposes of ongoing promotion of the CLD organization, programs and events. ■

I am the parent/guardian and give this student permission to participate. ■

Registration Fee: $25

CLD is located at 2425 Dr. Martin Luther King Jr. Street, Indianapolis, IN 46208

Office: 317.923.8111 Fax: 317-923-8112

© 2012 Center for Leadership Development, All rights reserved.