CORE Application

Please fill out the following information and press the SUBMIT button. Fields marked with * are required.
For more information call the Golden Apple Foundation at 312/407-0006 x109.

*	First Name:
*	Last Name:
*	Address:
*	City:
*	State:
*	Zip Code:
*	Email Address
*	Phone Number:	- -
	School
	Are you a Scholar?	yes no
	Are you a Scholar?
	Are You a Fellow?	yes no
	If you are not affiliated with Golden Apple, how did you hear about CORE?
*	Do you need on-campus housing during CORE?	yes no
*	Do you need housing the night before CORE begins?	yes no
	If a friend or colleague is attending CORE, and you'd like to request them as a roommate, please provide their name here.
	Grade level interest	Check all that apply: Pre-K - 3 4 - 6 7 - 8 9 - 12
	Fee for conference
	Would you like to make a donation to Golden Apple in addition to your registration fee?	$0 $10 $20 $50 $100 Other: $

	Total:
*	I would like to pay by:	Credit Card Check



	Payments made by check should be sent to: Golden Apple Foundation, CORE 8 S. Michigan Ave, Suite 700 Chicago, IL 60603