Community Classroom Application

Semester applying for:

Full Name: *

Student ID#: *

Mobile Phone:

Other Phone:

Preferred Email:

Birthday:

T-shirt Size:

Will you reside in San Diego this summer?:

Summer Address:

Summer Phone:

Major:

Classification in fall:

Is an internship/practicum required for your major?:

If yes, what type of internship?:

How many hours a week?:

In nursing, what clinical placement will you have?:

Do you have food allergies?:

Do you require special accommodations?:

What interests you about this program?:

What do you expect to learn through this program?:

Do you have a car?:

A car is not necessary. We encourage you to think about not bringing one. Public transportation will be provided. We believe this will enhance your learning experience.

Do you speak other languages?:

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