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RESULTS Mentoring MiLeap OST Summer Camp

Summer Camp Registration Form RESULTS Mentoring 18135 E. Nine Mile Road, Eastpointe, MI 48021

Note - you must be at least 13 to attend our camp.  See grade choices below.

Summer Program Details 

June 29 -  August 1, 2026 

Program Hours: 8 am - 1:00 pm

Grades Served: Students must be at least 13 years old and in grades 7 - 12.

Notes - 100% Free for Families (grant funding received)! Learn about Music, STEM and Energy Training; Entrepreneurial Training with Mentoring Sessions.

STUDENT Date of Birth
Month
Day
Year
What grade is your child in currently?
7th Grade (Must be at least 13)
8th Grade (Must be at least 13)
9th Grade
10th Grade
11th Grade
12th Grade
What is your child's racial and/or ethnic identity?
American Indian, Indigenous, Native American or Alaskan Native
Black or African-American
Asian or Asian-American
Hispanic or Latinx
White or Caucasian
Native Hawaiian or Pacific Islander
Multiracial
Prefer not to answer
Other
What is your child's gender?
Male
Female
Non-Binary
Prefer Not To Answer
Does your child have a special education plan, individual education plan (IEP) or 504 plan as part of their school's education?
Yes
No
Not Sure
Is your child an English learner or English as a second language student?
Yes
No
At school, is your child eligible to receive free lunch?
Yes
No
Did your child attend a MiLEAP School Program last year (2025)? ?
Yes
No
Students who register for MiLeap programming commit to attending programming throughout the summer. This is not a drop in program and it is important that the students attend daily to receive the full program benefit. Will your student be able
Yes
No

Along with assessments, your child will be asked to complete in a post-survey after the program so that we can evaluate the program successes and challenges tis year and continue to improve the MiLeap Program.  No further action is required to provide consent for your child to participate.  If you prefer for your child NOT to participate. please notify us at info@resultsmentoring.org confirming that you want to OPT OUT of student surveys.


By submitting this enrollment application, I, The parent/guardian, consents to be contacted by MiLeap Administration and/or service providers.

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RESULTS MENTORING, 18135 EAST NINE MILE ROAD, EASTPOINTE, MICHIGAN, 48021, UNITED STATES

877-378-5873, INFO@RESULTSMENTORING.ORG

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© 2025 by RESULTS Mentoring.  RESULTS Mentoring is a 501(c)3 organization.  All Rights Reserved. 

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