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Gear Up - RSU


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Gear Up University
Application


Appreciating Real World Technology (ART)
Rogers State University, Claremore
June 14-19, 2015

Student Information
*
First Name: * Middle Name: * Last Name: *
Home Address: * City: * State: * ZIP: *
County: * Cell Phone: * Email: *
Gender: * Birth Date: * Race: *
Tribe:    Tribe Name:   
Parent Information
First Name: * Middle Name:    Last Name: *
Home Address: * City: * State: * ZIP: *
Home Phone: * Cell Phone: * Email: *
School Information
School Attended: * Phone: *
Address: * City: * State: * ZIP: *
County: *

In the space below, describe why you (the student) want to attend GEAR UP University and what you expect to gain from the experience.
*

If you have questions about GEAR UP University, please email ethrower@osrhe.edu or call 800-858-1840.