Student Registration Form: Summer 2023

Deadline to Register: June 21, 2023

Student name:*

First Last

Gender (used for housing assignments)

Birthdate*

Student email:*

This email address will be used to set up the student WordPress account for use during workshops as well as for contacting student prior to the start date.

Student home phone:

Student cell phone:

Parent/guardian name:*

First Last

Parent/guardian email:

Student home address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Background (choose all that apply)

Black/African American
Asian
White
Hispanic/Latino
American Indian/Alaska Native
Pacific Islander/Hawaiian
Other

If you chose "Other" above please list background in the text box below.

Have you attended the IU High School Journalism Institute in the past?*

Yes
No

How many years have you attended HSJI (including this summer)?

Two
Three
Four

How did you learn about the HSJI workshops? (Please check all that apply)*

High School Teacher/Adviser
Parent/Grandparent/Family Member
Flier picked up at journalism convention
Flier/postcard received through U.S. Mail
E-newsletter from The Media School
Ad in the C:JET magazine
Facebook Ad

Other

Student serving on staff of: (if applicable)

Newspaper
Yearbook

Staff position: (if applicable)

Editor
Reporter
Photographer

Publication circulation:

How many newspapers/yearbooks does your school distribute for each edition.

Publication (annual) budget:

School enrollment:*

Approximately how many students are enrolled at your school?

How many semesters of high school journalism have you completed?*

Journalism/media adviser or school contact name: (please put n/a if not applicable)*

First Last

Journalism/media adviser or school contact email: (please put n/a if not applicable)*

Journalism/media adviser or school contact phone #:

Student standing as of fall 2023:*

High school name:*

High school address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Roommate request: (if applicable)

First Last

Please choose the session/s that you will attend:*

July 10-14
July 16-20

Please choose the workshop that you would like to attend during the July 10-14 session:*

Please choose the workshop that you would like to attend during the July 16-20 session:*

Between session stay-over: (if applicable)

Friday, July 14
Saturday, July 15

There is a $30/night additional fee to stay between sessions.

Between session stay-over: (if applicable)

Friday, July 14
Saturday, July 15

There is a $30/night additional fee to stay between sessions.

Local Commuter:*

Yes
No

Choose "Yes" if you plan to stay with a friend or relative in-town and not in the dorm.

Name of friend/relative you will be staying with:*

First Last

Phone of friend/relative you will be staying with:*

T-shirt size:*

Please note: you MUST also complete the payment form, which will open up shortly after clicking the Submit button below. Once both forms are complete and have been received a space will be reserved for you. A confirmation packet will be emailed to you.

Thank you!

High School Journalism Institute

Deadline to Register: June 21, 2023

Support HSJI

New Student Work