Register for GenCyber NW Cyber Camp @ Clackamas Community College Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.NW Cyber Camp 2024 Registration Form – Clackamas Community College NW Cyber Camp at Clackamas Community College will be held from July 29th through August 1st. Filling out this form will register your student for cyber camp and reserve their spot within our program. Registration and attendance is free. After completing this form a member of NW Cyber Camp staff will review and provide confirmation of your registration within 2 business days. While registration will reserve your spot in camp, additional application materials are required and must be completed within 10 days of your registration. Families who are unable to fully complete and provide all of the items listed below within 10 days of initial registration risk their spot in camp being forfeit. All waivers and releases, once completed, must be emailed to [email protected]. Required documents: A teacher letter of recommendation/support. Completed set of waivers and releases (download) Please direct any questions to [email protected] NW Cyber Camp is a program working in partnership with University of Oregon and administered by the Oregon Cybersecurity Center of Excellence at Portland State University Camp Selection Location *Clackamas Community CollegeClassroom Type *Co-edAttendee Information Please provide information about the individual who will be attending camp. Attendee Name *FirstLastAttendee Email Address *Join Student E-Mail List *YesNoOur student mailing list is used to make students aware of student-focused opportunities such as educational events, career fairs, and other cybersecurity events targeting our student population. Parents will always be copied on all student-targeted emails. Current School *Current Grade *7th Grade or earlier8th Grade9th Grade10th Grade11th Grade12th GradeGender *BoyGirlNon-BinaryT-Shirt Size *X-SmallSmallMediumLargeX-Large2X-Large3X-LargeDoes the attendee have any food or other allergies we should know about? *YesNoDescribe any allergies *Guardian/Household Information Please provide information about one legal guardian of the individual who will be attending camp. This individual will be our primary guardian contact. Parent Name *FirstLastParent Email Address *Join Parent E-Mail List *YesNoOur parent mailing list is used to make parents aware of NW Cyber Camp news, future camps, and future student cybersecurity events.Parent Phone Number *Mailing AddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency Contact Please provide at least one emergency contact. In the case of an emergency while your student is attending camp, emergency contacts will be contacted in the order listed below when the primary guardian contact is not available or unresponsive to contact attempts. Emergency Contact 1 Name *FirstLastEmergency Contact 1 Phone Number *Emergency Contact 2FirstLastEmergency Contact 2 Phone NumberEmergency Contact 3FirstLastEmergency Contact 3 Phone NumberMisc. Questions and Acknowledgements Who is completing this registration? *I am a student completing it on behalf of myself.I am a parent completing it on behalf of my child.A teacher letter of recommendation or support will be required to finalize registration.I understandIn order to attend NW Cyber Camp, a letter of recommendation or support from one of the student’s current teachers must be provided. This letter must be provided via email to [email protected] within 10 days of registration.While registration reserves a spot in camp, additional steps will be required in order to fully complete a registration. *I understandWhile registration will reserve your spot in camp, a completed set of waivers and releases must be provided to [email protected] within 10 days of registration.Each student's guardian must complete all of the required releases and waivers to finalize their student's registration. *I understandDue to the nature of our camps, we are not able to exclude individual students from photos and video recordings. Parents or guardians who are unable to complete any required release or waiver will surrender their student’s NW Cyber Camp reservation.The information in this form is being collected by NW Cyber Camp and will be shared with your selected camp host institution. *I understandThe information in this form is being collected by NW Cyber Camp, a program working in partnership with University of Oregon and administered by the Oregon Cybersecurity Center of Excellence at Portland State University. The information provided will only ever be shared with the campus hosting the camp that you selected. NW Cyber Camp will not share you or your student’s information with any other third parties.Optional Demographic Questions In order to help better accomodate future student populations, please consider answering the following demographic questions. For questions specific to an indivdual, please answer on behalf of the student who will be attending camp. Which of the following best describes the highest level of education completed by any member of your household?Decline to AnswerDidn't Finish High SchoolHigh School Graduate or GEDSome college but no degree2-year college degree (associates or equivalent)4-year college degree (bachelors or equivalent)Master's degree (or other post-graduate degree)Doctoral Degree (PhD, MD, EdD, JD, DDS, etc)What is your approximate annual household income?Decline to AnswerLess than $40,000$40,000 – $59,999$60,000 – $80,000$80,000 – $100,000$120,000 – $149,999Over $149,999Does anyone in your household currently work in cybersecurity or a related field?Decline to AnswerYesNoIn a related fieldWhich related field?Are you of Hispanic, Latino, or Spanish origin?Decline to AnswerYesNoHow do you describe your ethnicity?Decline to AnswerAsianBlack or African AmericanNative AmericanWhite or CaucasianPacific IslanderUnknownOther/Self-DescribePlease describe your ethnicitySubmit