Please provide the following information for the student that is applying. To enter information for more than one student please complete another application.
First Name
Last Name
Student Email
Birth Date
Gender
Current School
T-Shirt Size
Upcoming Fall Standing
Dietary Restrictions
Race
List any health restrictions, allergies, medications taken by the child or any other needs that might affect your child’s participation in program activities. NO medications will be distributed by program staff.
List any behavioral or learning needs your student may have
Are you a New or Returning Student?
Email
Mobile Phone
Work Phone
Relationship to Student
Address Information
Address Line 1
Address Line 2
City
State
Postal Code
How Did You Hear About Our Program?
Essay Questions
Please list any academic or educational awards and honors you received?
Extracurricular and volunteer information
Multimedia information (optional)
Please answer the following question in 650 words or less: Why is STEM (science, technology, engineering, and mathematics) important to you?
Last Semester Report Card Upload
Your digital signature below confirms all information in this application (including any supplemental information) is factually true and honestly present and that you are the person submitting this application.
