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Summerpalooza
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Summerpalooza Application
Summerpalooza Application 2024
The Program
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 University of San Diego (USD) for a 3-day, 2-night trip. The boys session will be held from Friday, June 21, 2024 through Saturday, June 23, 2024 and the girls session being held on Friday, June 28- Saturday, June 30, 2024. During the trip, students will stay at the USD dormitories and will meet students from PREP programs from other high schools LEARN serves. Students will explore the USD campus, get a preview of campus life, and learn about themselves and others as they prepare for adulthood. The cost of attendance for this trip is more than $1000 per participant, but recipients of the Summerpalooza Scholarship will be fully funded by PREP to attend this trip at no cost to them.
Eligibility
Applicants to the Summerpalooza Scholarship must meet all of the following criteria: (1) Students must attend an EMUHSD, ERUSD, PUSD or WUHSD school and be a current 10th or 11th grade student in the 2023-2024 school year. (2) The applying student may NOT be a graduating senior.
Awards
24 scholarship awards will be granted to students currently in the 10th and 11th grades. Scholarship award amounts will cover full costs of visit to University of San Diego 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
To apply for the Summerpalooza Scholarship, please complete and submit the the form below. Please ensure you have the following: (1) Complete and Sign Application. The application must be signed by both the student and parent/guardian. Please list at least one teacher or PREP staff member to contact as a reference.
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
Student's School Name
*
Please Select School
Arroyo High
California High
El Monte High
El Rancho High
Frontier High
La Serna High
Ledesma High
Mountain View High
Pioneer High
Rosemead High
Salazar High
Santa Fe High
Sierra Vista High
South El Monte High
Village Academy
Whittier High
ID Number (Student IDN)
*
High School GPA
*
Student Name
*
First
Middle
Last
Student Gender
*
Please select one
Female
Male
Other
Prefer not to say
Student Grade Level
*
This is the grade that you're currently in.
Please select a grade
current 10th grader (Sophomore)
current 11th grader (Junior)
Student Date of Birth
*
(mm/dd/yyyy)
MM
1
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DD
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YYYY
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Student Age
*
Student Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Student Daytime Phone Number
*
Student Evening Phone Number
*
Student Mobile Phone Number
Student Email
Referred by:
If applicable, please enter the first and last name of anyone who referred you to the program. This might be a Site Coordinator, a school teacher, a past Summerpalooza alumni, etc.
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
Hidden
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.
Select a short answer question
Please explain why you should be awarded this scholarship.
Why do you wish to attend Summerpalooza at University of San Diego?
What are your plans after high school?
Hidden
Short Answer Document Upload
Please ensure that your file is in either PDF or Word Doc format.
Max. file size: 2 GB.
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.
Reference Name
First
Last
Reference Phone
Reference Email
PARENT/GUARDIAN INFORMATION
Parent/Guardian #1 Name
*
First
Last
Relationship to Student:
Parent/Guardian Occupation:
Parent/Guardian #1 Email
*
Enter Email
Confirm Email
Parent/Guardian #2 Name
First
Last
Relationship to Student:
Parent/Guardian Occupation
Parent/Guardian #2 Email
Emergency Contact Name
First
Last
Emergency Contact Phone Number
Relation to Student:
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
*
Hidden
Physician's Name
Hidden
Physician's Phone Number
### - ### - ####
Hidden
Health Insurance or Health Plan Provider
Hidden
Health Policy/Plan Number or Member ID
Emergency Contacts
Emergency Contact #1 - NAME
*
First
Last
Emergency Contact #1 - HOME PHONE NUMBER
*
### - ### - ####
Emergency Contact #1 - MOBILE PHONE NUMBER
*
### - ### - ####
Emergency Contact #2 - NAME
*
First
Last
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 in USD residence halls on campus. Students are required to remain on the USD campus in designated program areas under the supervision of assigned LEARN staff for the duration of the trip. Students agree to follow 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 the University of San Diego. 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.
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.
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, you will be automatically redirected to a page where you will review the information you entered and electronically sign the completed registration form. After signing, you will be able to save and print a copy of the signed form, in addition to being emailed a PDF copy of the form.
Signature
Phone
This field is for validation purposes and should be left unchanged.
Next Step: Print, fill out and turn in the USD Consent form to your Site Coordinator
Click HERE to access USD Consent Form
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