Connections 2022 – Student Application Form (Hampton Roads)

Home 9 Connections 2022 – Student Application Form (Hampton Roads)

2022 Hampton Roads Connections Student Application

Please complete the form by May 22, 2022. 

In order for selected students to attend the program, they must also have a parent or guardian sign a permission form (in addition to signature below). Permission forms will be sent out after the information form is received, and due by June 15.

NOTE: You cannot save your partially completed form so please review the full form before starting to complete.

Student Information

Please complete the following section with the student's name and contact information
Please write the full school name (ex: Virginia High School) without abbreviation (ex: VHS)
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Accommodation requests will only be used to help VCIC plan a program that is as accessible as possible
Your selection does not need to be final at this point, and you can change your mind at any time.

Please provide the following demographic information.

*This information will be used to ensure that we have as diverse a community as possible.*

Short Answer Questions

Please respond to the following three questions using the text box below (no more than 500 words total). This is not a graded assignment, so please write in a way that is most comfortable to you. We are wanting to learn about you and will not be judging responses based on English proficiency or spelling and grammar. Your submission must be your own original content and has to be created specifically for your Connections application form.
  1.  Explain why you are interested in attending Connections, and what you hope to gain from the program.
  2. What are you currently involved in at school or in your community?
  3. From your perspective, what are the biggest issues facing your school or community?
500 Word Limit
Signature is required.

Parent / Guardian Consent

Signature is required.

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