Hometowns Louisville Accepted Students Form | Supreme Court Historical Society

1. Legal Name

First

Last

2. Preferred Name

3. High School

4. Grade (2026-27 school year)

10
11
12

5. Home Address

Address Line 1

Address Line 2

City

State

Zip Code

6. Personal Email Address (Not School)

7. Parent / Guardian Email Address

8. Emergency Contact #1

First

Last

Centre provide program

Phone

Relationship

9. Emergency Contact #2

First

Last

Phone

Relationship

10. Do you have any food allergies or medical concerns of which program staff should be aware? Please list below:

11. How will you commute to the program? (Both for the August orientation and the Wednesday after school sessions)

I will be driving and will need parking
I will be dropped off
I will be using public transportation
Other (please specify)

Other (Question 11)

12. For day 1 of the orientation and our final session in December, you will need to provide photo ID when arriving at the U.S. District Courthouse. Which of the following do you have?

Drivers License
Photo ID
U.S. Passport or Passport Card
I do not have a government issued photo ID

13. I confirm that I am able to attend Monday 8/3 (U.S. District Courthouse, Louisville) and Tuesday 8/4 (Field trip to Centre College, Danville) each day for the entire time..

Yes
No

14. I understand my attendance is expected at all after school sessions and that I may only miss time due to an emergency or unavoidable circumstances. I should do my best to let Jamie know in advance of my absence.

Yes
No

15. If I do miss a session it is my responsibility to reach out to my group and make up all work completed during the session.

Agree
Disagree

16. I will be working with people who bring diverse personal experiences to this program. I will be respectful to anyone with whom I interact.

Agree
Disagree

17. I will fully participate and be engaged in each session of the program.

Agree
Disagree

18. A brief bio (100 words or less) that will help us get to know you better.

19. When working in groups, what role or roles do you typically take? (you can select more than 1 response).

Group leader – organizes group members, helps facilitate completing work, ensures all members have a task and remain on task
Creative/Graphic designer – organizes layout/structure of product, ensures all work is legible and presentable, has artistic eye
Tech guru – knows how to work online programs (especially Canva) and may record information from other members
Researcher – digs in to find resources and information to use in product
Presenter – shares project with larger group, asks clarifying questions to overall project organizers
Other (please specify)

Other (Question 20)

20. Fun Fact: We will be playing a get to know you game, so please provide a unique fact about yourself that will help your peers get to know you.

21. Please upload a yearbook/headshot style photo of yourself (from the waist up). This picture may be shared in publications related to this program.

Drag & Drop Files, Choose Files to Upload

22. Please upload a signed copy of your permission slip. The paperwork can be printed, signed by your parent or guardian, and then either scan or take a photo and upload.

Drag & Drop Files, Choose Files to Upload

23. Please upload a signed copy of your release form. The paperwork can be printed, signed by your parent or guardian, and then either scan or take a photo and upload.

Drag & Drop Files, Choose Files to Upload