ENROLLMENT FORM 2013-2014
Local Phone #: (
Primary E-mail address:
Secondary E-mail address:
City, State, Zip:
Cell Phone #: (
City, State, Zip: Permanent Phone #:
Class Level: Freshman Sophomore Junior Senior
Expected Graduation Date: Incoming GPA (only if you are a freshman):
Cumulative UC GPA:
If you transferred to UCSD, please list name of college/university & the city
How did you hear about CAMP? (if from a friend, faculty or staff member, please list his/her name)
Please indicate your graduate or professional school degree objective:
Proposed field of graduate study (if any):
What is your career objective?
Have you ever participated in any of the following UCSD programs or any other
similar program at the University of California?
do not authorize,
the CAMP Coordinator/Office to publish,
when appropriate , my name, class level, major, and photo on the CAMP
Website or in CAMP/AEP publications as: CAMPís Leadership Prize recipient, CAMPís GSAA recipient, Provostís Honorsí
Awardee, UCSD Graduate, starting, attending or having completed graduate school,
Summer/Academic year Research Program and/or Internship participant,
participating in a conference, recipient of
other honors, awards or scholarships, etc. I understand that I will not be compensated for this use. Please note that not agreeing to this release will
not affect your membership and status in CAMP.
Please review the above information to make sure that is a
correct representation of yourself. Then digitally sign your name in the box
below and submit your application.