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Anytown Fee:  380 - includes the following: round-trip transportation, meals, housing, accident insurance and workshop material.

Financial Aid is available based on need.  Please check the the box in the application to request information.

A $30 registration fee is due with the application.  The remainder of the Anytown fee is due after you received your acceptance letter into the program

Name:
Address:
City:
State, Zip Code:
Phone Number:
Email Address:
High School:
Grade (Fall 08)
	To ensure ethnic, gender, cultural, and religous diversity at Anytown please provide the following information about yourself.
Gender:
Race:
Religion:
Please Select Session Preference	June 21-26 August 3-8 No Preference
How did you hear about Anytown?
Why are you interested in attending Anytown?
Do you require any specific accommodations for diet or accessibility? If so, please describe.
	PARENT/GUARDIAN CONSENT I give permission for the applicant to attend CCSJ's ANYTOWN 2008
Parent/Guardian Name:
Parent/Guardian Signature:
Day Phone Number:
Financial Aid/ Scholarship Requested?	Yes No

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