ODU GenCyber Camp Participant Registration

Old Dominion University's GenCyber summer camps will recruit 50 middle and high school students, particularly JROTC students and military kids entering grades 7 through 12, to learn cybersecurity, develop an interest in cybersecurity, and acquire cybersecurity knowledge and hands-on skills. The two summer camps (Camp1: July 10-14, 2023; Camp2: July 17-21, 2023) will run on-site at ODU Norfolk camps. For further information, please contact gencyber@odu.edu. Besides summer camps, students will also participate in pre-camp and post-camp activities which are scheduled in May and October 2023, respectively.

You may return to complete this form. You have 30 days from beginning the form to complete it.

Student Name Student Name First Last
For Last Name, enter last name or family name.
Student Email *
Parent's/Guardian's Name Parent's/Guardian's Name * First Last
For Last Name, enter last name or family name.
Parent's/Guardian's Relationship with you (i.e. Parent, Grandparent, Sibling, Guardian,) *
Parent's/Guardian's Mailing Address Parent's/Guardian's Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent's/Guardian's Email *
Parent's/Guardian's Phone for Emergency Contact Parent's/Guardian's Phone for Emergency Contact * - ### - ### ####
Please provide alternative emergency contact/s including: Name, relationship,address, phone and email *
Which Camp would you like to join? Both camps are held 9 a.m. to 4:30 p.m. Monday through Friday. *

Which Camp would you like to join? Both camps are held 9 a.m. to 4:30 p.m. Monday through Friday. Camp 1: July 10-14 Camp 2: July 17-21
Can you attend every day of camp from Monday through Friday? *

Can you attend every day of camp from Monday through Friday? Yes Other Other
Have you taken any courses in computer science and/or cybersecurity? *

Have you taken any courses in computer science and/or cybersecurity? Yes No
Please list the courses you have taken.
Do you have any experience in cybersecurity? *

Do you have any experience in cybersecurity? Yes No
Please describe your experience.
What are your objectives in attending camp? *
What is your school's name? *
What is your school's address? What is your school's address? *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
What is your school's phone number? What is your school's phone number? * - ### - ### ####
Which Junior ROTC program do you attend? (If applicable.) *

Which Junior ROTC program do you attend? (If applicable.) Naval JROTC Air Force JROTC Army JROTC Marine Corps Not in any JROTC program Other Other
Entering Grade *

Entering Grade 7 8 9 10 11 12 Other Other
What is your current GPA? *
Ethnicity (Check all that apply) *

Ethnicity (Check all that apply) African American American Indian/Alaska Native Asian Hispanic/Latino Native Hawaiian/Other Pacific Islander White/Caucasian Other Other
Multiple Choice *

Multiple Choice Male Female Other (Please list preferred pronouns) Other (Please list preferred pronouns)
Do you qualify for free or reduced-price school meals? *

Do you qualify for free or reduced-price school meals? Yes No
Do you have a parent serving in the military? *

Do you have a parent serving in the military? Yes No
T-Shirt Size (Adult) *

T-Shirt Size (Adult) XS S M L XL XXL
How did you hear about Gen/Cyber Camps (Check all that apply.) *

How did you hear about Gen/Cyber Camps (Check all that apply.) Email from Old Dominion University Old Dominion University website Friend or teachers at school Social media Internet search Other Other
Finished revising this form and ready to submit? Check the box below. Once a form is started, you have up to 30 days to submit changes until the deadline date of July 1. All submissions will be reviewed at that time.

Finished revising this form and ready to submit? Check the box below. Once a form is started, you have up to 30 days to submit changes until the deadline date of July 1. All submissions will be reviewed at that time. Yes, I am ready to submit my application.