Senator for a Day Registration Form

Friday, October 17, 2025 | 8:30 am – 2:00 pm
Northampton Community College – Monroe Campus

Registration Deadline is Friday, September 26, 2025.

Senator for a Day Seminar

Advisor(s):
Advisor Contact Number:
Advisor E-Mail Address:

School Name
School District: (For Home School Students)
Student 1
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 2
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 3
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 4
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 5
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 6
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 7
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 8
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 9
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 10
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 11
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 12
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 13
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 14
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Student 15
Student Name:
Committee Choices: Please mark 1st, 2nd and 3rd choices only per student
Transportation Communications and Technology Health and Human Services Education Law and Justice
Phone
This field is for validation purposes and should be left unchanged.