Anytown Delegate General Information Application 2023 

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Anytown
Anytown is NCCJ's flagship youth leadership and human relations summer camp. Click here to learn more about Anytown.

To be eligible to attend Anytown as a delegate, you must be a rising high school sophomore, junior or senior and you must attend a school in Guilford County or live in Guilford County.

To complete this application, you will need the name, contact information (phone and email), title, and school or organization of a community member willing to support your application.

At any time you can save your progress (check the box at the top of the form) and come back to finish and submit it later. Should you need assistance completing this application please contact Alison Whitman Jones at ajones@nccjtriad.org or (336) 272-0359 x 130.
Applicant Information


















(Ex: man, woman, transgender man, transgender woman, etc.)











Next page:  Parent/Guardian information

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Parent/Guardian Information
Parent /Guardian #1



















Parent /Guardian #2



















Next Page:  Demographic information:

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Demographic Information
To ensure diversity at Anytown, we ask that you please check any/all of the following that apply to you:  (This information is confidential and will be viewed by NCCJ staff only.  It will not be used or disclosed for any other purposes.)











Next Page:  Community member endorsement

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Community Member Support
Anytown challenges students to discuss their experiences with and attitudes about human relations issues. That's why NCCJ asks each student applicant to get support from a community member, such as a teacher, counselor, principal, supervisor, or faith leader. By supporting the student application, the community member is agreeing that the student is physically, emotionally, and mentally capable of participating in Anytown.

Please provide the name of a community member that we can contact for support of your application. 







Next page:  Tuition, fees and tuition assistance

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Tuition, Fees & Tuition Assistance

Cost of Attending
  • The full cost of attending Anytown is $650.
  • $50 of the $650 is a non-refundable registration fee. 
  • If you register and pay in full by April 15, we will waive your $50 non-refundable registration fee.

Tuition Refunds from Cancellation/Early Departure

  • A 50% refund of tuition will be made upon written request when a cancellation is made at least three weeks before a session. 
  • A full refund of tuition will be made due to illness. 
  • To receive a refund, submit your request to Alison Whitman Jones (ajones@nccjtriad.org) before August 1st
  • No refunds will be given for a delegate who leaves a session early.

 

Tuition Assistance:

  • Generous, need-based tuition assistance is available to all applicants. 
  • Please indicate below whether you are applying for tuition assistance and how much of the full cost of attending Anytown ($650) you can pay. 
  • All information provided will be kept confidential.


ex: $25, $100
ex: $25, $100

We accept cash, checks, money orders and all major credit cards. For credit card payments, please call our office or click here to pay online.


By signing below, I verify that I have thoroughly read the information listed in the tuition, fees and tuition assistance section of this application. I give my permission for the young person named above to apply as a delegate for NCCJ's Anytown 2023 residential program.