Application for MPDC Historically Black Colleges & Universities (HBCU) Tour 2025 (February 17-19, 2025)

Application Instructions:

Thank you for your interest in the MPDC HBCU Tour 2025 happening February 17-19, 2025! We’re thrilled that you’ve chosen to apply.
Our online application process is straightforward and divided into 6 short sections:
Student Information
Personal Reflection
Parent/Guardian Information
Parent/Guardian Agreement Acknowledgement
Participation Fee/Scholarship Opportunity
Application Acknowledgement and Consent
Please ensure that you complete all the information on each page, carefully review your details at the end, and then submit your application. The entire application is due December 20, 2024 by 11PM.

Important Reminders:
Fields marked with an asterisk (*) are required.
You must click the 'Finish' button at the end to submit your application to the MPDC HBCU Tour 2025 team.
Double-check your application before submitting it.
Please note, the application must be completed in one session. If the form remains idle for more than 20 minutes, your session will expire, and you will need to start over.
We look forward to reviewing your application!

Student Information

Please provide the following details to help us get to know you better. All fields marked with an asterisk (*) are required.

Full Name:

Preferred Name:

Date of Birth:

I identify my gender as:

Are you a MPDC resident?

YesNo

Home Address ( Street, City, State, Zip Code)

Phone Number:

Email Address:

Emergency Contact Name:

Emergency Contact Phone Number:

Relationship to Emergency Contact

School Name:

Current Grade Level

Upload a copy of your most recent transcript

Expected Graduation Date:

T-Shirt Size:

Do you have any dietary restrictions or allergies?

Yes (Specify below)No

Please specify any dietary restrictions or allergies here (enter N/A if none)

Do you have any medical conditions, allergies, or require any medication that we should be aware of to ensure your safety and well-being during the HBCU tour? If yes, please provide details below, including any necessary accommodations. (enter N/a if none)

Have you previously participated in any MPDC Youth Development programs?

Yes (Specify below)No

Please highlight your involvement here (enter N/A if none)

How did you hear about this opportunity?

Personal Reflection

Please choose one of the following prompts and respond in at least 300 words:

1. Reflect on a significant challenge you have faced in your life. How did you overcome it, and what did you learn about yourself in the process? How will these lessons shape your journey at an HBCU?

2. What are your academic and career goals, and how do you believe attending an HBCU will help you achieve them? Describe specific programs, resources, or opportunities at HBCUs that align with your ambitions and how you plan to make a positive impact during your time there.

3. As you consider your future and the possibility of attending an HBCU, reflect on how your education can help you make a positive impact in your community. What specific skills, knowledge, or experiences do you hope to gain from attending an HBCU, and how do you plan to apply these to address challenges in your community?

Upload Writing Sample

You may submit an existing writing sample or a new personal reflection as part of your application. Please note that this submission is a key component of the selection process. Failure to provide a writing sample may negatively impact the review of your application

Edit this text

In your response, consider sharing specific experiences, lessons learned, and how these shape your future goals. Your response must be at least 300 words. If submitting a writing sample, please enter "N/A"

Parent/Guardian #1 Information

First Name

Last Name

Phone Number:

name@domain.com

Parent/Guardian #2 Information

First Name

Last Name

Phone Number:

name@domain.com

Parent/Guardian Acknowledgment of Agreement

Please read the following carefully and indicate your agreement by checking the appropriate boxes.

NOTE: This section is intended to be completed with a parent/guardian.

Overnight Rules & Roommate Selection Guide

Please review the full guidelines by clicking the link below:

MPDC HBCU Tour 2025 Rules & Guidelines

Liability Release

I hereby give my consent for my child to participate in the Madison Park Development Corporation (MPDC) Historically Black Colleges & Universities (HBCU) Tour 2025. I also consent to my child traveling to and from this event via transportation approved by MPDC. I have instructed my child to follow all directions given by the staff, adhere to all safety guidelines, and avoid any unsafe behavior. I acknowledge that I have received a copy of the MPDC HBCU Tour rules, expected behavior, and code of conduct. I understand that if my child engages in behavior deemed unacceptable or unsafe for themselves, other participants, or staff, they may be removed from the tour.

I agree to the Liability Release terms.

Authorization for Emergency Medical Treatment

In the event of an injury, illness, or emergency, I hereby authorize the administration of any necessary medical, dental, or surgical treatment, including examinations, operations, emergency transportation, and the use of anesthesia or blood transfusions for my child. This consent extends to any physician or dentist in attendance at the medical facility. I also consent to the release of medical reports to relevant doctors or agencies and the admission of my child to a hospital if required.

I agree to the Authorization for Emergency Medical Treatment terms.

Indemnity Agreement

On behalf of myself and my child, I hereby waive any liability of MPDC, including its officers, agents, staff, and volunteers, for any injuries, financial obligations, or liabilities resulting from my child's participation in the tour. I accept full financial and legal responsibility for any injury, illness, or emergency treatment my child may require during the tour.

I agree to the Indemnity Agreement terms.

Photo and Social Media Consent

By allowing my child to participate in the MPDC HBCU Tour 2025, I, as the parent/guardian:

Give consent for MPDC to take photos and videos of my child during the tour. I understand that these images may be used for promotional purposes on MPDC’s website, social media, newsletters, and reports.

Do not give consent for MPDC to use photos and videos of my child.
.

2025 MPDC HBCU Tour Participation Fee & MPDC Scholarship Opportunity

The total cost of this trip is $599.00. The fee covers transportation, lodging, lunch, dinner, and admissions to the National Museum of African American History. Students will need additional money for souvenirs and other incidentals.

Payment Options:

The cost for students to attend MPDC HBCU tour is $599. Deposits and Full Payment can be made by the following methods:

Cash (exact amount)
Certified Check/ Money order– payable to Madison Park Development Corporation
Credit Card – Using GiveSmart

Payments can be made weekly, or monthly and final payments are due by 1/24/2025. $100 deposit is due by 12/13/2024 (still accepting deposits). Students are encouraged to pay in person at MPDC to Yvette Jordan, Director of Operations. No cash is accepted via mail.

Scholarship opportunities are currently available. Kindly complete the section below to determine your eligibility for the MPDC HBCU tour scholarship. Following the review of your application, a member of the MPDC staff will follow up to communicate your eligibility status.

Financial Commitment Confirmation

Do you acknowledge that you are currently able to cover the full cost of the MPDC HBCU Tour ($599.00) without requiring financial assistance?

Yes, I acknowledge that I am currently able to cover the full cost of the MPDC HBCU Tour ($599.00).

MPDC HBCU Scholarship

For those who may need financial assistances, please fill out the following section to determine eligibility.

Please note: Proof of income and other required documents must be brought to MPDC at 184 Dudley St., Suite 200, Roxbury, MA 02119 before the 1/10/25 deadline.

Income Vertification

Household Size (Total number of people in your household, including yourself):

Annual Household Income (Total income for all members of your household for the past year):

Are you currently receiving any other form of financial assistance or benefits? (Examples: SNAP, Section 8 Housing, SSI, TANF, or Masshealth Insurance)

YesNo

Statement of Need

Please describe why you are applying for this scholarship and how participating in the MPDC HBCU tour will benefit you and your educational goals (Minimum 300 words) Please note: this is required if applying for scholarship opportunity

Application Acknowledgment and Consent

Eligibility Criteria Acknowledgment

I acknowledge and agree to the following terms:

Eligibility Criteria: I meet the requirements to attend, including being an 11th or 12th grader, Boston resident, maintaining a minimum GPA between 2.5 and 3.0 GPA. (Note: If my GPA is below 3.0, I understand that additional documentation of community involvement may be required) and submitting all sections of the application. MPDC has the final say on eligibility.

Acknowledgment Section I

I acknowledge and agree to the terms and conditions of participation, including:

Meeting the eligibility criteria set by MPDC.
Following all trip rules and guidelines.
Accepting that failure to comply with these rules may result in being sent home at my own expense.
Understanding that MPDC has final authority on all eligibility and participation decisions.

Acknowledgment Section II

By submitting this application, you acknowledge that you have read, understood, and agree to abide by the rules and guidelines outlined for the MPDC HBCU Tour 2025.

Please review the full guidelines by clicking the link below:

MPDC HBCU Tour 2025 Rules & Guidelines

I have read and agree to the MPDC HBCU Tour 2025 Rules & Guidelines