Full Name *

Date of Birth *

Applicants must be 16 years old as of July 1 of the current year.

Email Address *

Phone Number *

Mailing Address *

T-shirt Size *

Enter required value Small Medium Large XL XXL

Name(s) and Relationship *

(father, mother, legal guardian, etc.)

Cell Number *

Emergency Contact Name and Cell # (if different from above) *

What high school do you currently attend? *

Highest grade completed as of June 2025 *

(select from drop-down list)

Enter required value Sophomore (10th grade) Junior (11th grade) Senior (12th grade)

How did you learn about EPIC Week?

school counselor/teacher

social media

parent/guardian

friends

other

Essay Requirement *

Submit a 250-500 word essay that includes the following information:

• what you hope to gain from the EPIC Week experience
• how you feel this experience will help support your future career

20MB max

Do you have a summer job? *

Enter required value yes no

Share any extracurricular activities that you are involved in (or would like to be involved in). *

Do you hold a specific leadership role at school, in the community, at work, or within your family? *

How have you contributed to your community in the past year? *

Agreement of Terms *

By completing and submitting this form, I agree that the information in this form is true at the time of completion. I understand that my name and other information I have provided here, along with my photo, may be used in announcements and news related to the Regional Chamber's EPIC Week program.

I agree that the decisions of the Selection Committee are final and non-appealable. 

Enter required value I agree