2026 Junior Civics Leadership Academy Registration You must have JavaScript enabled to use this form. Student Information Student Name First Name Last Name Student Date of Birth Student Home Address Address Address 2 City/Town State/Province - Select - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ZIP/Postal Code High School Enter the name of the high school you attend. Student Incoming Grade - Select - 10 11 12 Student Sex - Select - Male Female Phone Student Email Student T-shirt size - Select - S M L XL XXL XXXL XXXXL Student Allergies Yes No Student Allergies Notes Parent Information This person will serve as the main point of contact. Parent Name First Last Parent Address Address Address 2 City/Town State/Province - Select - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ZIP/Postal Code Parent Phone Parent Email I acknowledge that the Stennis Institute will send me an invoice. I acknowledge that registration does not guarantee placement in JCLA If you have any questions, please contact Kendall Sanders at 662-325-3328 or at comms@sig.msstate.edu. If you feel uncomfortable submitting information on this form, you may send an email with this same information to Kendall Sanders at comms@sig.msstate.edu. Leave this field blank
