Thank you for your interest in our CAMP program! Please complete this application as thoroughly as possible. You cannot save and restart this application. You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application. If you have any questions, please call our office at (208) 792-2913.

Student General Information

First Name *

Middle Name

Last Name *

Gender *

Date of Birth *

Are you Hispanic or Latino? *

(Check All that apply)

American Indian or Alaska Native

Hispanic or Latino

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Citizenship Type *

Mailing Address *

City *

State *

Zip Code *

Cell Phone Number

Home Phone, if different

Email *

Academic Information

High School Graduation Year *

High School *

College major I'm interested in *

Mother has bachelor's degree *

Father has bachelor's degree *

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Eligibility Information

Are you or will you be a freshman at Lewis-Clark State College? *

Are you eligible to receive federal financial aid (FAFSA)? *

Have you or one of your immediate family members worked as a migrant or seasonal farm worker in the areas of agriculture, dairy, fisheries, or forestry for at least 75 days within the last 24 months? *

Are you eligible to participant in a Ch. 1 Migrant Education Program? *

Are you qualified or eligible to qualify for the Workforce Investment Act 167 Program? *

Academic Need (check all that apply)

Writing essays

Research papers

Reading for meaning

English as a second language

Basic math

Algebra

Advanced Algebra

Study skills

Library skills

Critical thinking

Career exploration/counseling

Adjusting to college life

Time Management

Budgeting for college

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Emergency Contact Name

Emergency Contact Number

FOR APPLICANT: By electronically signing below, I certify that the information on this form are true, complete and accurate to the best of my knowledge. I give permission for CAMP to share this information with other appropriate agencies. If I am awarded CAMP assistance, I agree to do my best in class and follow the rules and regulations of the program and institution to successfully complete one academic year (25 credits) at Lewis-Clark State College. Failure to disclose and submit complete, accurate information may result in the denial of acceptance to the Lewis-Clark State College CAMP program.

Student Signature *

Please select a signature verification type.