Contact Information

Ben Franske, Ph.D.

Information Technology Faculty

Meriem Aman

GenCyber Program Director

GenCyber Participant Registration Form

Who:   Students entering grades 9, 10

What:   GenCyber Camps

When:   July 17th - 21st, 2017 | 9:30 a.m. - 4:00 p.m.

Where:   Inver Hills Community College

Cost:   $0.00 - FREE

Fields marked with a (*) are required.

Student First Name:*  
Student Last Name:*  
Street Address:*  
City, State, Zip:* ,      
Date of Birth:  
Grade entering in Fall 2017:*  
Have you participated to the GenCyber Camp at Inver Hills Community College last year?
Have you ever attended any GenCyber Camp in Minnesota?

Completion of This Section is Voluntary:

Ethnic Origin:

The information requested is needed for reporting and research purposes. It will be kept confidential and will not be used as a basis for enrollment or in a discriminatory manner. The information collected will be used for summary reports required by federal and state laws and regulations to support institutional affirmative action. Summary reports do not identify individuals. Refusal to provide any of the requested information will not affect your enrollment. Students with disabilities are encouraged to contact the Supplemental Services Coordinator on campus to arrange appropriate support services.

Parent/Guardian Name:*  
Parent/Guardian Phone: *