Summer Youth Academies

Please note: * (asterisk) Indicates a required field.

Pattie Gomez
Senior Program Coordinator
patricia.gomez@csus.edu

Parent Contact Information

*Parent First Name

*Parent Last Name

*Parent Email Address

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Student Contact Information

*Student First Name

Student Preferred First Name

*Student Last Name

*Student Email Address

*Student Birthdate
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Population_CCE (Hidden field)

Yes

No

Program - Summer Youth Academies (Hidden Field)

Student Type - Youth (Hidden Field)

Program Coordinator - PG (Hidden Field)