Champion Referral

**Must submit application and referral form prior to the second day of the camp student will be attending.

Your First Name

Your Last Name

Your Email

Relationship to Student

Student First Name

Student Last Name

Student Email Address

Student Phone Number

Student School Name Search (Name, City, CEEB): Please start typing your school's name and click on the result to populate the address information*
If your school is not listed, please start by typing "Unknown" in the field below. Please do not abbreviate

School Code (please make sure to fill out the box above and click the result to populate this field)

Student Address

Country

Street

City

Region

Postal Code

Graduation Year

Comments/Additional notes you would like to share for this student