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Student Profile
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Gender
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How did you hear about ACT-SO?
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Are you a McLean County Resident?
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Please select the categories of interest to you.
(Three (3) categories maximum)
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CULINARY
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Media Release
I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of the Student named above. I also grant to the right to edit, use, and reuse said products for non-profit purposes including use in print, on the internet, and all other forms of media. I also hereby release the Bloomington-Normal ACT-SO and its volunteers from all claims, demands, and liabilities whatsoever in connection with the above.
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Parent and Student Accountability
The mission of the Bloomington-‐Normal ACT-‐SO program is to nurture excellence and provide positive reinforcement to African-‐American high school students. We will accomplish this by engaging students in a quality 7-‐month program of monthly enrichment sessions, educational/informational sessions, a community volunteer project, mentoring opportunities, field trips, and more. Students are expected to be fully engaged and committed; and their parents/guardians are expected to support, monitor, and encourage their participation.
Through the commitment of our supporters, partners, volunteers, and steering committee, we will provide leadership, encouragement, and guidance. The responsibilities of parents and students are as follows:
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Please check boxes *
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Registration: $40
(Includes a year membership in the NAACP and a monthly subscription to the CRISIS Magazine.)
A processing fee has been included for credit card payments. You will be redirected to PayPal to make payment when submitting this form.

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Total
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