Cameron Connection – College Prep Camp
Freshman Application Packet
June 13 - 18, 2016
Name: ____________________________________________________
Last
First
Name tag: ___________________________
MI
Birthdate: ______________________________
(first name to appear on name tag)
Gender: Male or Female
Adult T-Shirt size: _______________
Mailing Address: __________________________________________________________________________________
City: ______________________________ State: __________ Zip: ____________ County: ______________________
Home Phone: ______________________________________ Cell Phone: _____________________________________
Email: ___________________________________________________________________________________________
School: _________________________________ Grade in Fall 2016: ______________ Exams: ACT
or SAT
Roommate(s) Request (tentative): _____________________________________________________________________________
Race: Voluntary, for reporting purposes only, and will not be a factor in selection. (Please circle only one)
American Indian/Alaska Native*
Hispanic
Asian
White
*Tribe: ________________________________
Black/African American
Prefer not to respond
Native Hawaiian/Pacific Islander
None of these
Tribal Lineage: Mother
Father
Both
Unknown
LONG TERM EDUCATIONAL GOALS
1st Generation: (Will you be the 1st member in your family to earn a college degree?)
or
No
Bachelor’s Degree (4-year degree)  


Masters Degree 

Professional Degree (Doctor, lawyer, pharmacist, etc.) 




Yes
Associate Degree (2-year degree) 
Career Choice(s): ___________________________________________________________________________________
Name of Physician: ____________________________________________ Phone: ______________________________
Medical/Hospital Insurance Carrier: __________________________________________________________________
Hospital of Choice: _________________________________________________________________________________
Dietary Restrictions/Allergies: _______________________________________________________________________
Physical Restrictions: _______________________________________________________________________________
In Oklahoma, the meningococcal vaccine is required for students who are enrolling for the first time in college or in posthigh school educational programs and will live in dormitories or in on-campus student housing. While your child is NOT
required to have received this vaccine prior to attending the Cameron Connection – College Planning Camp, we do
encourage parents to consider this vaccination as a precaution. For more information about protecting your teen against
meningococcal disease contact your local health department or http://www.cdc.gov/meningococcal/about/index.html.
Emergency Contacts - Release of information and/or camper will be authorized only to the adults designated below:
Parent/Caregiver: ________________________________________________Contact Phone #: _____________________
Emergency Contact: ______________________________________________Contact Phone #: _____________________
Emergency Contact: ______________________________________________Contact Phone #: _____________________
Consent and Certification: I, the undersigned, being the parent or legal guardian of the child named on this registration packet, do
hereby consent to the participation of my child in all the regularly scheduled activities of the Cameron University Cameron
Connection College Planning Camp, including instructional activities, outdoor activities, and any other activity customarily associated
with an academic camp. Further, I certify my child is physically fit to participate in activities except those specifically listed by the
parent or legal guardian.
Medical Treatment Authorization: I understand that I will be notified in the case of a medical emergency involving my child. If, in
the event I or the emergency contacts cannot be contacted, I authorize the camp adult in charge to consent to the providing of
necessary medical services (generally Comanche Count Memorial Hospital) if my child is injured or becomes ill. I understand that
Cameron University and/or the Cameron Connection College Planning Camp will be not be responsible for medical expenses incurred
solely on the basis of this authorization.
Damage Responsibility: I understand that participants in the Cameron Connection College Planning Camp are liable for intentional
or malicious property damage. Repair costs for damages caused by a participant will be billed directly to the parent or legal guardian.
Photocopies or electronic copies of this signed registration packet will be considered valid.
Parent/Guardian Signature: _________________________________________________ Date: __________________
Student Statement: By signing and returning these documents, I understand that I am agreeing to attend and participate in the
Cameron Connection College Planning Camp. I am also acknowledging that I have read and understand all documents contained
within this registration packet.
Student Signature: _________________________________________________________ Date: __________________
**NOTE: Contact will be via EMAIL-please check periodically. If unavailable, contact will be made by phone or postal mail. **
Deadline to submit completed application: May 13, 2016
Please return:
By mail:
By fax:
By email:
In person:
Questions:
Cameron University, Adult & Continuing Education
2800 W Gore Blvd., Lawton, OK, 73505
580-581-2590
loray@cameron.edu
Cameron University, South Shepler, 4th Floor, Rm 415
580-581-2284
This institution in compliance with all applicable Federal and State laws and regulations does not discriminate on the basis of race, color, national origin,
sex, age, religion, political affiliation, disability, or status as a veteran in any of its policies, practices, or procedures. This includes but is not limited to
admissions, employment, financial aid, and educational services. This notice is provided as required by Title VI of the Civil Rights Act of 1964, Section
504 of the Rehabilitation Act of 1973, Title IX of the Education Amendments of 1972, the Age Discrimination Act of 1975, and the Americans with
Disabilities Act of 1990. Questions, complaints, or requests for additional information regarding these laws may be forwarded to Sylvia M. Burgess, the
designated Compliance Coordinator at the address provided above.
Please write a short essay describing your educational and career goals and why you think you should be
selected to attend the Cameron Connection - College Planning Camp. (You may print your essay on this sheet
or attach a typed essay no more than one page typed, 12 point, double spaced.)
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
Cameron Connection – College Planning Camp
Permission Form
___________________________________________________
(Applicant Full Name)
_________/_________/_________
(Date of Birth)
___________________________________________________________
(High School)
This student will be a freshman during the upcoming school year at the school listed above. I recommend this student for
attendance at the Cameron Connection – College Prep Camp beginning summer 2016.
__________________________________________
(Signature of Principal)
_______________________________
(Date)
I recommend this student for attendance at the Cameron Connection – College Prep Camp beginning summer 2016.
__________________________________________
(Signature of Counselor)
________________________________
(Date)
Parental permission is given to this student to attend, if selected, Cameron Connection – College Prep Camp June 13-18, 2016.
By signing below I understand that if my student is committing to attend the camp for two summers to complete the college prep
curriculum. I further understand and give permission for my student to attend this overnight camp and stay on the Cameron
University campus through the duration of the program. I agree to provide assistance to my student to prepare to attend the camp
and to assist in arranging travel for my student to and from Cameron University prior to and following the camp dates.
__________________________________________
(Signature of Parent/Legal Guardian)
________________________________
(Date)
As an applicant, I understand that by submitting my application for this program I agree, if selected, to attend the complete camp
from beginning to end and to be an active participant through the duration of the camp.
___________________________________________
(Signature of Student)
________________________________
(Date)
Photo/Information Release Form
Cameron University may take pictures and videotape Cameron Connection – College Planning Camp students
and activities. These pictures will be used to promote the program, give recognition to the camp, and document
program activities to our donors.
In order that your child receive information on scholarships and other educational programs, it may also be
necessary for Cameron University to share information about him/her with institutions throughout the state.
Any sharing of information will be used to promote your child’s educational opportunities only.
As parent/legal guardian of the student named below, I grant permission for Cameron University to use my
child’s photo/video, other multimedia images and recordings of my child and program participation information
in any area designed for publicity/education purposes and hereby releases them of any responsibility or
obligation.
Student’s Name
Signature of Parent or Guardian
Mailing Address
City
Phone Number
State
Zip
Date
If you DO NOT wish for your student’s photos/videos, other multimedia images and recordings or
information to be shared, please fill out the portion below.
I DO NOT want my child, __________________________________, to be included in any photos/videos,
other multimedia images and recordings or share any of their information.
Signature of Parent or Guardian
}
CAMERON CONNECTION SUMMER CAMP RULES
Welcome Campers! Below are provided the guiding rules that are provided to ensure you have a great time at Camp. We take the supervision of
our Campers very seriously. It is important that Campers understand these rules in advance. The rules are designed to provide protection of
Campers. We want all our Campers to enjoy a productive, pleasant and safe stay on our campus.
Note: Any violation of these rules, or of the Code of Camper Conduct, may result in a decision that it is in the best interests of the Camper(s)
involved and the remaining Campers that a Camper be removed from Camp. Before any decision is made to expel a Camper, a full investigation
will be made by Camp/University administrators or by Public Safety, as determined appropriate based upon the circumstances resulting in the need
for investigation. As soon as practicable, the involved Camper(s) parents/guardians will be notified to come pick the Camper up and to immediately
remove the Camper from Camp. The involved Camper(s) will not participate in Camp activities during the time the Camper is awaiting the arrival
of his/her parent/guardian. The specific policies to be followed are detailed in the Code of Camper Conduct and Disciplinary Procedures, provided.
General:
1. Time and Attendance. Campers must be on time and attend all sessions/activities during the week of camp.
2. Name Tags. All campers must wear name tags around necks at all times when campers are out of dorm rooms. The camper’s name must be
visible. Do not cover with stickers. The name tag is your passport to eat in the cafeteria, to enter dorms and the Aggie Rec Center, and attend
evening activities.
3. Attitude. A positive attitude and enthusiastic participation in all activities is expected.
4. Language. Profanity, vulgar language, ethnic or gender slurs, and other inappropriate conversations or comments are strictly prohibited.
5. Conduct/Bullying. Violence, bullying, harassment and threatening or insulting comments will not be tolerated.
6. Displays of Affection. Campers are prohibited from engaging in displays of affection during the course of the camp. This rule prohibits both
mutually agreeable displays of affection as well as unsolicited hugging, kissing, grabbing, hand-holding, pinching, bumping, or other touching, and
extends to prohibit writing of notes, phone calls, text or other electronic types of messages etc. to other Campers during the course of Camp.
7. On Campus Required. Campers may not leave campus without prior approval from the Camp Director, and may only leave campus in the
presence of a staff member, sponsor or parent/guardian. When permission has been granted, the camper must ensure the mentor and student
assistant are informed before the camper departs. As a general rule, parents/guardians must approve before a camper leaves campus.
8. Tobacco, Drugs, Alcohol Prohibited. Possession or use of tobacco (all forms), drugs or alcoholic beverages is prohibited. Cameron is a tobacco,
drug and alcohol free campus.
9. Visitors. If a camper, or the camper’s family, wants to have a visitor on campus or to leave campus at any time during the course of camp,
permission must be obtained in advance from the Camp Director. If the visitor is other than the parent/guardian, the parent/guardian must also
approve the request for a visitor. As a general rule, permission will not be granted for a camper to leave campus during the camp unless it is with
the parents/guardian and only for a brief period of time.
10. Medical Incidents and Costs. Campers will be responsible for any medical costs incurred by or on behalf of the camper during the week of camp.
The Camp is located across the street from Comanche County Memorial Hospital, which hosts a full emergency room facility. Camp staff and the
campus police department will be on duty 24/7 during camp to deal with medical concerns, and to determine whether campers need external
medical assistance. Parents/guardians will be contacted immediately if external medical assistance is determined necessary.
11. Medication. Campers are responsible for administering their own medication. The Camp staff will NOT administer or provide any medication or
across the-counter drugs. Campers must bring or purchase their own medication.
12. Gadgets. Use of cell phones, texting, etc. will not be permitted during class time.
13. Lost Items. Please report lost items immediately. Although Cameron University cannot be held responsible for items lost by Campers, we will
make all reasonable efforts to assist in locating the lost items.
14. Professional Demeanor. Campers must display appropriate, professional demeanor at all times during camp, and particularly during the
Sophomore Showcase. This means appropriate attire, and no food, drink, or GUM allowed during the Sophomore Showcase.
Library/Computer Labs:
1. Library/Photocopying. Campers may use the library at authorized times, and may photocopy materials. {Copy cards may be purchased for $1
each, plus any amount the camper chooses to add to make copies. NOTE: The copy card loader machine does not give change…if you put in $20,
you will get a $20 copy card. The first 10 copies per card will cost $2 (20 cents each), then 10 cents per page thereafter.} No materials may be
checked-out of the library, or removed from the library for any period of time.
2. Food/drink. No food or drink allowed in library or any of the computer labs.
3. Running/Noise/Abuse of Materials. Running and loud talking are prohibited. Campers will not hide library/computer lab materials.
4. Campus PC Access. Must have assigned username and password to log onto computers.
Cafeteria:
1. Name Tags Required. In order to be served, Campers must wear their own name tags at all times.
2. Running/Discourtesy/Dish Clean-up. Campers will not run and will not save places for other Campers, or cut in the cafeteria line. When finished
eating, Campers must carry their dishes and any trash to the cafeteria conveyor belt.
3. Sufficient Food/Please Do Not Waste! The cafeteria serves “all you can eat,” but please be thoughtful of others. Do not take more food than you
plan to eat while in the cafeteria. Do not waste food.
4. Cafeteria Food Available Only For Cafeteria Dining. Food may not be carried out of the cafeteria for later consumption.
5. Courtesy. Please be courteous to the food service employees. They return the courtesy to our Campers in many ways.
Continued on next page…
6.
Water. We recognize it is important to stay hydrated. Campers will be issued water bottles. An ice/water machine is available free of charge for
all campus participants. The machine is located just outside the cafeteria, beneath the south stairwell, on the first floor of Shepler Center.
Dormitory:
1. Dormitory Floor Time Requirements/Lights Out. Campers must be on their floors by 10:00 p.m. each evening. Campers may not leave the
floor for any reason after 10:00 p.m. Lights out at 11:00 p.m. each evening. There will be random ROOM CHECKS every night!
2. Male/Female Separate Quarters. Male Campers/guests are not permitted on the Female Camper floors, and Female Campers/guests are not
permitted to be on the Male Camper floors at any time over the entire course of the Camp.
3. Phones/Use. There are land line telephones in most rooms, and all rooms are inventoried prior to check in. Any room that has a telephone at the
time of check in must have the same telephone, in the same working condition, at the time of check out. Any phone that is not in the room, or not
in the same condition as it was at the time of check in will be charged to the Camper assigned to that room at the rate of $65.00. Phones are
provided for the convenience of Campers. Campers must use phones appropriately. Prank, harassing, annoying, and unwelcome calls are strictly
prohibited.
4. Room Keys/Elevator Cards. Room keys will be assigned to each Camper, and must be safeguarded. Campers will be charged $20.00 for a lost
room key. (When keys are lost, Facilities must install new locks.) Elevator cards will be assigned to chaperon’s during camp. These cards allow
Chaperon’s to escort Campers to their dorm floors. Chaperon’s may not lend their elevator access card to any other person at any time.
5. Safeguard valuables/Lock Room. Campers must not leave money or other valuables unattended in their rooms. Campers should keep their
rooms locked at all times.
6. Elevator Horseplay Prohibited. Campers are prohibited from pushing the emergency buttons on elevators unless an actual emergency occurs.
7. Adult Supervision. Sponsors and staff members will be occupying various rooms on each floor assigned to Campers (every 3 or 4 rooms). They
will be available for assistance at all times when Campers are authorized to be on the Dormitory Floors.
8. Running prohibited. Running is prohibited in all areas of Shepler Center, including the dormitories, hallways, and foyer. Please reserve running
and high impact activities for outside during approved times.
9. Courtesy. Campers must be polite to all other Campers, staff, Cameron students, and visitors and others they meet, pass, or interact with over the
course of the Camp, including any staff that may be assigned to desks in the dormitory reception or Main Desk areas.
10. Music/TV/Talking/Noise. Campers are welcome to listen to music and television, and to talk on the phone during free time; however, Campers
must show courtesy and respect for the rights of others in adjacent rooms. Any noise should be contained solely to the Campers’ rooms beginning
at 11:00 pm each night. Headphones should be considered for those who wish to listen to music or television at a louder volume than is acceptable
to those in other rooms.
11. Room Changes. Campers may not switch rooms after camp begins except in extreme circumstances, and only when approved by the Camp
Director for good cause.
1) I have read the above CAMP RULES and agree to abide by the rules; and
2) I understand that Cameron University is not responsible for providing medical attention. All pharmaceuticals, medicines, hospital, medical bills, and any
across-the-counter drugs are to be paid by me or my parent(s) or guardian(s). Cameron Connection will assist me in obtaining any necessary medical care, and
in the event of an emergency, will notify my parents/guardians and/or family doctor immediately. (If religious beliefs are held by my family that would
complicate normal procedures, I will notify the Camp Director in writing on or before the first day of the academy.)
_______________________________________________________________________________________________________________________________
Camper’s Signature (mandatory)
Date
_______________________________________________________________________________________________________________________________
Parent/Guardian Signature (mandatory)
Date
HAVE FUN! LEARN A LOT! BE SAFE! BE NICE!
CAMERON CONNECTION Frequently Asked Questions (FAQs)
What is Cameron Connection – College Prep Camp?
A FREE summer camp program held on Cameron University’s campus. Cameron Connection is designed to help
upcoming freshman and sophomore students develop a plan and prepare for attendance at the college of their choice.
The program is intended to be fun and informative. Attendees will leave with an action plan and the appropriate steps
required for admission and ultimately attendance at the college of their choice.
How much does it cost?
Thanks to a generous donor, there is no cost to students. Participants need to bring bedding, toiletries, and clothes, as
well as arrange for transportation to and from Cameron University. In order for every student to have the opportunity to
attend Cameron Connection, please contact us in the event of financial hardship. We can supply some or all of the
required necessities (sheets, blankets, towels, socks, hygiene products).
When is the camp?
June 13-18, 2016
What will students learn?
Students will learn all about the things they need to consider when choosing a college or university and how to prepare
based on those. Students will set academic goals, discuss financial planning and scholarships, learn about college
experiences, learn about major and career choices, discuss test preparation and more. In addition, students will
participate in fun activities with other camp participants including movie nights, activities in the Aggie Rec Center, an
resume writing and interviewing skills workshops. For a more detailed breakdown of the program content, please visit
www.cameron.edu/cameronconnection/about.
How do I apply?
Complete the following steps no later than May 13, 2016:
1.
2.
3.
4.
Complete application form and write a short essay. (form enclosed)
Obtain all required signatures on the permission form. (form enclosed)
Attach copy of current school transcript or report card to application.
Return application packet:
By Mail:
Adult & Continuing Education, Cameron University, 2800 W Gore Blvd., Lawton, OK 73505
By Fax:
580-581-2590
By Email:
loray@cameron.edu
In Person: Cameron University, South Shepler 4th floor, room #415
How many students are selected?
Approximately 25 freshman students will be selected to attend this year’s camp.
When will I find out if I am selected?
Selected students will be notified early in May of his or her selection into the program. The selection packet will include
details regarding the program and will have additional forms that must be completed, signed and returned prior to
arrival at Cameron Connection.
For more information visit www.cameron.edu/cameronconnection, email loray@cameron.edu or call (580) 581-2284.