Summerpalooza Application

Summerpalooza Application 2026

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Phone

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OVERVIEW OF SUMMERPALOOZA

LEARN is excited to bring back Summerpalooza, an overnight college experience for high school students focused on personal development and exploring options for life beyond high school graduation! This summer it will be happening at Cal State San Marcos for a 3-day, 2-night trip. The boys session will be held from Friday, June 12, 2026 through Sunday, June 14, 2026 and the girls session being held on Friday, June 26, 2026 through Sunday, June 28, 2026. During the trip, students will stay at Cal State San Marcos and will meet students from PREP programs from other high schools LEARN serves. Students will explore the Cal Sate San Marcos campus, get a preview of campus life, and learn about themselves and others as they prepare for adulthood. Summerpalooza is FREE!

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Eligibility

Applicants to the Summerpalooza Scholarship must meet all of the following criteria: (1) Students must attend an EMUHSD, ERUSD, PUSD, NLMUSD or WUHSD school and be a current 10th or 11th grade student in the 2025-2026 school year. (2) The applying student may NOT be a graduating senior.

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Awards

100 scholarship awards will be granted to students currently in the 10th and 11th grades. Scholarship award amounts will cover full costs of visit to Cal State San Marcos for three days and two nights. Scholarship amount includes cost of transportation, room and board, and other activities totaling more than $1000 per student attending. If selected, students will not pay anything out of pocket.

APPLICATION REQUIREMENTS

Complete and submit the form below. The application must be signed by the student's parent/guardian.

EQUAL OPPORTUNITY

LEARN is an Equal Opportunity Non-profit Organization committed to providing all employees and program participants an environment free of discrimination and harassment regardless of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.

STUDENT INFORMATION

School Name*

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ID Number (Student IDN)

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High School GPA

Student Name*

First Middle Last

Student Gender*

Which weekend are you applying for*

Student Grade Level*

This is the grade that you're currently in.

Student Date of Birth*

(mm/dd/yyyy)

Student Address*

Street Address Address Line 2 City State ZIP Code

Student Phone Number*

Student Email*

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Academic Plans

Please select the response that most accurately completes the following sentence: “After I graduate from High School, I plan on …

Attending a 4-year College or University

Attending a Community College

Attending a Vocational School

Working Full Time

Joining the Military

Other

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Short Answer Questions

Please select ONE short answer question and answer in its entirety. Your response must be at least 150 words and no more than 500. It must be uploaded below as a PDF or Word Doc.

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Short Answer Document Upload

Please ensure that your file is in either PDF or Word Doc format.

Max. file size: 2 GB.

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Reference

The reference must be a member of your school site (teacher, counselor, PREP Youth Leader, etc.). The recommender should be able to speak on your work ethic, collaboration skills, and character. They should also speak about any positive changes they have noted in you this year, and/or the effort they have seen towards your academics.

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Reference Name

First Last

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Reference Phone

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Reference Email

PARENT/GUARDIAN INFORMATION

Parent/Guardian #1 Name*

First Last

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Relationship to Student:

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Parent/Guardian Occupation:

Parent/Guardian #1 Email*

Enter Email Confirm Email

Parent/Guardian #1 Phone Number*

Parent/Guardian #2 Name

First Last

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Relationship to Student:

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Parent/Guardian Occupation

Parent/Guardian #2 Email

Parent/Guardian #2 Phone Number

STUDENT HEALTH HISTORY & INFORMATION

If your son/daughter is required to be administered medication during program hours, an "Authorization to Medicate" form must be completed and submitted to LEARN. The form requires the physician's signature. If you list any medications here, you will be emailed a printable copy of the form. A paper copy of this form can also be obtained from the Site Coordinator. Please follow the completion instructions on the form. If not applicable type N/A.

Medications*

Medical Conditions*

Allergies*

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Physician's Name

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Physician's Phone Number

### - ### - ####

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Health Insurance or Health Plan Provider

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Health Policy/Plan Number or Member ID

STUDENT DIETARY RESTRICTIONS

If your child has any type of dietary restrictions please fill out the following fields. Please List "N/A" if the fields do not apply to your child. If your child requires allergy medication to be administered during program hours in case of exposure to any food allergies an "Authorization to Medicate" form must be completed and submitted to LEARN. The form requires the physician's signature and a paper copy of this form can be obtained from the Site Coordinator of your child's school.

Food Allergy*

Please explain, in detail, ANY of your childs dietary allergies. (Type "N/A" if this does NOT apply to your child.

Dietary Restrictions*

Please explain, in detail, ANY of your childs dietary restrictions and or intolerances, (Example; Vegan, Vegetarian, Pescatarian, Lactose Intolerant) (Enter "N/A" if this does NOT apply to your child.)

Accessibility and Participation

Our organization is committed to ensuring that all students have equal access to program activities, including field trips. Requesting transportation or other accessibility accommodations does not affect a student’s eligibility to participate or approval for this field trip. Information collected is used solely to arrange access-related supports.

General Access Needs (Optional)*

Are there any access-related supports your child needs to participate fully in this field trip (e.g., mobility access, seating, sensory considerations)?

Transportation Access*

Does your child require accessible transportation in order to participate in this field trip?

If YES:

Please indicate the type of transportation accommodation needed (check all that apply):

Provide a brief description here, if necessary.

EMERGENCY CONTACTS

Emergency Contact #1 - NAME*

First Last

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Emergency Contact #1 - HOME PHONE NUMBER

### - ### - ####

Emergency Contact #1 - MOBILE PHONE NUMBER*

### - ### - ####

Emergency Contact #2 - NAME*

First Last

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Emergency Contact #2 - HOME PHONE NUMBER

### - ### - ####

Emergency Contact #2 - MOBILE PHONE NUMBER*

### - ### - ####

PROGRAM DESCRIPTION AND GUIDELINES

Summerpalooza is a 3-day, 2 night personal development experience focused on college and career exploration, thinking about personal goals for the future, and getting to know more about themselves as they interact with new people in a college setting. Students will stay at Cal State San Marcos. Students are required to remain on the campus grounds in designated program areas under the supervision of assigned LEARN staff for the duration of the trip. Students agree to follow all staff instructions. All school rules of conduct and behavior are in effect at all times. If a student fails to follow these guidelines, LEARN staff may call home to have the parent/guardian come and pick up the student from Cal State San Marcos. A major part of the experience involves getting to know new people from other communities and backgrounds and learn together during the trip. Students will be placed in groups made up of students from other high schools and assigned a roommate from another high school. Student participants are expected to fully participate in activities and demonstrate high levels of respect and courtesy to all students and staff during the trip. Please come prepared to learn with an open mind.

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CONSENT TO USE OF VIDEO OR PHOTOGRAPHY

My signature below authorizes the LEARN staff to photograph and/or film my child during the program and I hereby consent to the use of these photographs in LEARN’s promotional material.

CONSENT TO USE OF VIDEO OR PHOTOGRAPHY*

A checked box and my signature below authorizes the LEARN staff to photograph and/or film my child during the program and I hereby consent to the use of these photographs in LEARN’s promotional material.

I agree to the video/photgraphy policy.

I DO NOT agree to the video/photgraphy policy.

RELEASE OF INFORMATION

My signature below authorizes the exchange of information regarding my student's academic progress between the PREP staff and the staff at my student's school.

LIABILITY WAIVER

I hereby waive all claims against my child’s school district, the LEARN organization and its employees for injury, accident or illness occurring by reason of participation in the PREP Program. In case of an emergency, I authorize any licensed physician or hospital to render such medical aid as may be deemed necessary and/or desirable. Any cost/liability incurred for such treatment shall be my sole responsibility.

DIGITAL SIGNATURE OF PARENT OR LEGAL GUARDIAN

After clicking the SUBMIT button below, a copy of the completed form will be automatically emailed to the email address listed for parent/guardian #1.

Signature*

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Referred by:

List the student's first and last name, as well as the school they attend.

Summerpalooza Application