Summit the San Juans - Peak Programs Registration

Student Information

Fort Lewis College ID#

First Name

Last Name

Pronouns

Birthdate

Are you 18 years or older?

Yes

No

What academic area do you plan on majoring in at FLC?

Student Contact Information

Mobile Number

Email Address

City, State, Zip

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Email Address

Additional Information

How did you hear about Peak Experiences?

T-Shirt Size (Unisex)

Do you have any special dietary needs (vegetarian, vegan, dairy, allergies etc.)?

Please provide details about your dietary restrictions, specifically what you will/won't eat. For instance, if you have a peanut allergy, are you able to eat foods that "may contain peanuts" or " made in a factory with peanuts".

Briefly describe any medical conditions/special considerations to help us support your experience. List any equipment you may need (see packing list at http://fortlewis.edu/summitpl).

Please rate your level of physical fitness on a scale of 1-5 (5 being fit, 1 being unfit).

Please rate your level of experience with outdoor overnight hiking/backpacking on a scale of 1-5 (5 being experienced 1 being beginner).

Are you requesting financial support for the application fee?

Yes

No

If YES to assistance please answer the following questions:

1) Why do you want to attend Summit the San Juans?
2) How do you think Summit the San Juans will enhance your first-year at FLC?
3) What do you think the most challenging aspect of college is going to be?

Type your initials if you agree to the waiver at http://fortlewis.edu/summitwaiver
**If under 18, parent or legal guardian must initial to agree to the waiver

Once you hit submit you will get a confirmation email with a link to pay the $300 program fee. Please disregard this payment link if you have requested financial assistance.