AGR Program
Application 2026

2026 Summer High School Agriculture Program

Student Application

Please complete all required fields.

Participant Information

Name*

Date of Birth*

Gender*

MaleFemale

Mailing Address*

City*

State*

Zip Code*

Phone Number*

Alternate Phone Number

Email Address*

Have you taken AGR 101?*

YesNo

Tribal Affiliation

Select AGR Summer Course(s)*

AGR 101 Introduction to Agriculture - July 5 - July 17, 2026AGR 303 Beekeeping - June 14 - 19, 2026AGR 408 Field Experience - June 8 - 11, 2026

Primary Language Spoken in Your Home

Will you need transportation?*

YesNo

Parent/Guardian Information

Mother Name

Father Name

Mailing Address*

City*

State*

Zip Code*

Phone Number*

Alternate Phone Number

Employer Name

Work Phone

Other Contact

School Information

School Name*

School District

School Address

City

State

Zip Code

Grade Level*

COVID-19 Vaccination Information

Are you fully vaccinated for COVID-19?*

YesNo

Please provide the date of all vaccines

Emergency Contact Information

Name*

Relation*

Phone Number*

Medical Information

Do you have any medical conditions or allergies?*

YesNo

If yes, please explain

Major illness during the past year?

Date of last tetanus shot

Are contacts or glasses worn?

YesNo

Allergies to any medication

Does the student take prescribed or over-the-counter medications?

Primary Care Physician Name

Physician Address

Physician Phone

Student Essay Questions

Student Name*

Please share with us: In what way have you showed interest or experience in agricultural science or farming?*

How do you plan to incorporate your newfound knowledge learned during this summer course into your family and community?*

Parental Consent and Photo Release

By submitting this form, the parent/legal guardian gives permission for the student to attend the Summer High School Agriculture Program in Tsaile, Arizona.

The parent/legal guardian understands the program rules, COVID-19 risks, room and board conditions, off-campus activities, supervision, safety expectations, and release terms.

I have read and agree to the parental consent terms.

I give permission to Diné College Land Grant Office to use photos, video, images, and/or statements of my child for marketing and promotional purposes.

Student Printed Name*

Student Signature*

Date*

Parent/Legal Guardian Printed Name*

Parent/Legal Guardian Signature*

Date*

On-Campus Summer Housing Application

Are you applying for on-campus housing?*

YesNo

Housing Session

Summer Session I 2026Summer Session II 2026

Last Name

First Name

MI

Student ID Number

Gender

MaleFemale

Birthdate

Major/Degree Seeking

Current Mailing Address

City

State

Zip Code

Physical Home Address

City

State

Zip Code

Cell Number

Diné College Email Address

Housing Emergency Contact

Name

Phone Number

Relation to Student

Name

Phone Number

Relation to Student

Room and Meals

Room/Meal Selection

5-week Double Occupancy - $4905-week Single Occupancy - $59010-week Double Occupancy - $98010-week Single Occupancy - $1180

Source of Income

How will you be paying for on-campus living expenses?

Pell GrantScholarshipsOther

If other, please list

Housing Medical

Do you have any medical conditions that require attention or prescribed medication?

NoYes

If yes, explain and list all medication

Accommodations

Do you have special accommodation needs or ADA accessibility needs?

NoYes

If yes, explain

Convictions

Have you ever been convicted of a felony or do you have any criminal charges?

NoYes

If yes, explain

Acknowledgement

I certify that all information given in this application is complete and accurate.

Student Signature

Date

Parent/Guardian Printed Name, if student is under 18

Parent/Guardian Signature

Date

Upload Supporting Documents, if needed