Participant Information
What is your status with Math CAMMP? New Enrollee Returning
First Name Last Name MI
Grade Level (Fall 2012) Gender Birth Date (mm/dd/yy) 1st 2nd 3rd 4th 5th 6th 7th 8th male female
Fall 2012 School
Address City
State Zip Code (99999) NC
Home Phone Number (999-999-9999)
Please provide information below regarding special needs, medications, and/or allergies:
Parent Information. Please provide the information below in its entirety.
Parent's Name (First Name Last Name)
Parent's Day Phone Number (999-999-9999)
Parent's Email Address
Secondary Contact's Name (First Name Last Name)
Secondary Contact's Day Phone Number (999-999-9999)
Secondary Contact's Email Address (optional)
Secondary Contact's Relation
I do understand that my application is not complete until I submit the requested information on the following page. Please make sure to print the confirmation form that appears after clicking submit below.
Important: The following items must be mailed to the UNC Charlotte Office of Educational Outreach office no later than Monday, June 18, 2012:
Confirmation form with original parent signature and additional information required.
The total registration fee is $240 due by June 18. A $100 deposit is due upon submission of confirmation form. Credit card payments are accepted online here. Checks and money orders are acceptable at the address below.
Registration is not complete until receipt of the aforementioned confirmation page and payment.
You will receive confirmation regarding your application status after your application materials have been received. Please forward confirmation/payment to:
The Office of Educational Outreach 160 College of Education Building, UNC Charlotte 9201 University City Blvd. Charlotte, NC 28223-0001
If you have questions regarding the application process, please contact Victor Mack at (704) 687-8801 or vbmack@uncc.edu. Please contact Dr. Michael Green at (704) 687-8897 or mggreen@uncc.edu or Dr. Jack Piel at (704) 687-8731 or japiel@uncc.edu if you have programmatic questions.