Summer Institute Application

FREE · June 6 – July 3, 2026 · Monday – Thursday, 10:00 AM – 2:00 PM · Grant Place Office, Little Rock, AR

Minimum 2.5 GPA required

⏰ Application Deadline: May 7, 2026

Student and Parent Information

All fields marked with * are required. A parent or guardian must complete this application for students under 18.

STUDENT INFORMATION

Student Full Name *

Age *

Grade Level (Fall 2026) *

School Name *

Current GPA *

T-Shirt Size

Clubs, Sports, Organizations, or Extracurricular Activities *

PARENT / GUARDIAN INFORMATION

Parent/Guardian Full Name *

Email *

Phone *

City *

State

EMERGENCY CONTACT

Name *

Phone *

HEALTH AND INTEREST

Food allergies or dietary restrictions? (Lunch is provided daily) *

Any health conditions or accommodations we should know about?

Why are you interested in the Summer Institute? *

Any leadership, volunteer, or community experience?

How did you hear about the Summer Institute?

I confirm that the information provided is accurate. I understand this is an application and does not guarantee enrollment. I consent to Village Public Health contacting me regarding this application and related programming.