2019 CSN Nevada Promise Academy Registration Form

Thank you for your interest in the first CSN Nevada Promise Academy Summer Bridge Program! The next step is to fill out this separate registration form completely to confirm your attendance. By completing this form you are committing to attend all components of the Promise Academy Program this summer. You will be notified of your application status by May 31, 2019 at which point further forms or information may be required from you.  We look forward to seeing you there!

SECTION A: APPLICANT INFORMATION
Enter your CSN student Number or NSHE ID (ten-digit number)
EMERGENCY CONTACT
In case of an emergency, the following person may be contacted:
MEDIA AGREEMENT
I agree to be photographed / videotaped and/or to have my voice recorded by CSN or by an authorized assignee of CSN, or have the attached written statement attributed to me for educational purposes or to promote such purposes. I further agree that all rights in such photography, videography, recorded sound, written statement or related publicity materials will be the exclusive property of CSN, its authorized vendors / agencies and their respective assigns. I agree this authorization may permit, among other uses, the right and authority to use for trade or other purposes the reproductions of my image and/or voice or written statements through the media of photographic prints, digital images, video / film, slides, sound records, radio, television or other media.