Perry Initiative High School Outreach Program Application

Thank you for your interest in participating in a Perry Outreach Program! To ensure your application is processed smoothly, please make sure to fill out all required fields and stay within the character limits for the essay responses. This form does not auto-save. We highly recommend drafting your essay responses in a separate document and pasting them here when you are ready to submit.

Once you submit, you will receive a confirmation email. Note: You cannot make changes to your application once it is submitted.

If you run into any technical issues,  have questions or do not receive a confirmation email within 24-48 hours of submission, please reach out to our team at [email protected].

"*" indicates required fields

Contact Information

Parent/Guardian Information

Please fill out complete information for ONE parent only. We need to be able to contact your parent via phone or email.

Application Information

Please select the appropriate program location from the drop down menu.
If the program is in summer, choose the grade you are entering in the fall.

The below information is collected for reporting purposes only and will not be used in the student selection process.

Gender
Race

Essay Questions

School Information

Reference (Guidance Counselor or Teacher) Information

Please do not use a default email, like [email protected]