ODU Summer Cyber Camp Participant Registration

Old Dominion University's School of Cybersecurity is looking for up to 25 middle and high school students entering grades 7 through 12 to develop an interest in cybersecurity. Attendees will acquire basic cybersecurity knowledge through a week of fun-filled, hands-on exercises. The summer camp will run from Monday, July 14, through Friday, July 18, 2025. For further information, please email ckirkpat@odu.edu.

This form is available for 30 days after starting.

Student Name Student Name * First Last
For Last Name, enter last name or family name.
Student Email Address *
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 *
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
While prior experience is not required, or expected, have you taken any courses in computer science and/or cybersecurity? *

While prior experience is not required, or expected, 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? * - ### - ### ####
Entering Grade *

Entering Grade 7 8 9 10 11 12 Other Other
What is your current GPA? *
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.