2022 Rogers Scholars – Contact Information Form Basic Information First Name * First Last Name * Last Preferred Name * If you have a name other than your legal name that you would like to go by, please list it here. Parent or Guardian Names * Date of Birth * Gender * T Shirt Size * Small Medium Large X Large XX Large XXX Large Contact Information Non-School Related Email (School emails will not work on our system.) * County of Residence * Mailing Address * City * State * Zipcode * Student Phone Number * Parent Phone Number 1 * Parent Phone Number 2 * School Information County of School * Name of School * Camp Choice Which program dates can you attend? Both June 5-10 at Morehead State University July 24-29 at Lindsey Wilson College captcha If you are human, leave this field blank. Δ