Vibe Information Form

VIBE Information

Please complete the form by July 9, 2021.

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 July 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)
unisex adult shirt size
Accommodation requests will only be used to help VCIC plan a program that is as accessible as possible

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. You can choose how to respond. Some options include: writing a short response using the text box below (no more than 500 words), writing a poem or song, or creating a visual art piece. (If you record a song or create visual art, please submit it by uploading the file and use the text box below to share a few brief written sentences explaining how the piece relates to the three prompts.) 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 VIBE information form.
  1.  Explain why you are interested in attending VIBE, 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
Use this link to upload any visual art/audio/video files here, if you chose to do so. If your file is too large to upload, please email to
Signature is required.

Parent / Guardian Consent

Signature is required.

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