NG on Campus is offering up to $3000 in scholarships per student!! All you have to do is submit this form to enter and attend the monthly meetings for NG on Campus!! Check your Email/SMS for updates on Club Information and Gatherings!

First Name *

Last Name *

Date of birth *

What is your gender? *

Address

City

State

Country

Postal code

Phone *

Email *

Name of College / University You Attend *

Campus Location (North, South, West, Hialeah, Central) *

Student ID Number *

Expected Graduation Year *

What is your major or field of study? *

How involved would you like to be? *

Occasionally (events only)

Monthly involvement

Weekly involvement

Highly committed / leadership role

How many hours per week can you commit? *

Do you have your own car? *

Yes

No

If yes, are you willing to help with transportation when needed? *

Yes

no

Sometimes

Do you live on or off campus? *

On Campus

Off Campus

Emergency Contact:

Full Name *

Relationship to Patient (if applicable): *

Emergency Contact Phone Number

How would you prefer to be contacted? *

Phone Call

Text Message

Email

Do you consent to receive updates, event notifications, and communication from New Generation on Campus? *

Yes, I consent

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