2008 STEM Discovery Application

Application for Admission

Directions: Please submit the following form by June 20, 2008 for Session II. Space is limited, so early application is strongly encouraged.

In addition to this application section, each student must download a Recommendation Form to be filled out by a guidance counselor or math/science teacher:

(All fields in RED are required)

Last Name

First Name

Middle Name

Date of Birth

Gender

Male Female

I am a...

U.S. Citizen Permanent Resident

Choose the category(ies) that best describes your background. This information is optional, and will not affect admission, or be used in any discriminatory way:

American Indian/Alaska Native Asian Black/African Central American Hispanic/ Latino(a) White/Caucasian Other

CONTACT INFORMATION:

Mailing Address:

Street

Apartment#

City

State

Zip Code

Telephone

home cell other

Email

Permanent (home) address (if different):

Street

Apartment#

City

State

Zip Code

Parent or Guardian Contact Information:

Name

Relationship

Telephone

home cell other

Alternate Telephone

home cell other

Email

ACADEMIC INFORMATION:

In the Fall of 2008, I expect to be a...

Junior Senior

Name of Current High School

City

State

Please list the names of all the math and science classes you have taken (or are currently taking) during High School (grades 9-11). Please also include the grades you received.

Math

Science

Please list your extracurricular activities.

What career do you see yourself pursuing? If unsure, what fields would you like to explore?

Which session would you prefer to attend?

Session 1 (June 23 – July 18) Session 2 (July 21 – August 8)

(no classes held June 30-July 4)

Are you available to attend either of the two sessions?

Yes No

Please note that because of space limitations, we cannot guarantee admission into your preferred session. Those students that are available for either session may have more likelihood to obtain a space.