MIPA Meetup: MIPA's Student Advisory Cohort

We're so excited you're interested in participating in the MIPA Meetup! Please complete the form below to apply to join.

About You

First Name

Last Name

Your School Email

Your Personal or Home Email

Cellphone

Home Street Address

Home City

Home Zip Code

Date of Birth (MM/DD/YYYY)

Your School

Year of expected high school graduation

Media Program Name
Provide the name of the student media program in which you participate. This program should be a member of MIPA.

This media program produces a:

Print or online newspaper
Broadcast TV program
Yearbook
Website Only

Your position on staff

How long have you been a member of the staff?

Your Adviser

Adviser Name

Adviser Email

I received approval from my adviser to join the MIPA Meetup

Yes
No

Parents or Guardians
Provide information about at least one parent or guardian. This should be the parent who will complete any required permission forms.

Parent(s) or Guardian(s) Name(s)

Home Phone

Parent Cellphone

Parent Email

Are you ready to participate?

No
Maybe
Yes

Are you willing to attend various MIPA events and meetups?

What do you hope to get from this experience?

Comments or questions

After submitting this application form, you will be taken to SignNow to start the process for a parent or guardian to complete the required permission forms. Be ready to input a parent's email address on the next page to send them the first required permission form.

You can get more information about MIPA Meetup permission forms at http://mipamsu.org/mipameetup#forms

Ready to submit?