<p>Columbus State University STEM Camp Application</p><p>Instructions. Please type your responses in the blue text boxes provided. The boxes will expand, if needed, so that your complete response can be entered.</p><p>Student’s full name:</p><p>School name:</p><p>School address: Street City State Zip code</p><p>Current grade (please put an X in the appropriate blank): 6th 7th 8th </p><p>What is your date of birth (enter numeric date as mm/dd/yyyy)?</p><p>Home contact information: Parent name: Street City State Zip code Phone Parent email Student email</p><p>Please list all extra-curricular activities in which you are participating this school year. 1.</p><p>Please discuss what interests you about math and science. (250 or fewer words) </p><p>Please describe what you like to do for fun. (250 or fewer words) </p><p>Why do you wish to participate in the STEM Camp at Columbus State University? (250 or fewer words) </p><p>Revised 2/8/16 Please list any awards you have received in the past 2 years. 1.</p><p>Please list any careers you are considering. 1.</p><p>Please rate the importance of each factor in your decision about a career (place an X in appropriate column). Very Somewhat Not a Somewhat Very Importan Important Factor Negativel Negatively t y Important Important The work is fun The work is intellectually stimulating Passion for the work Better understand the world Helping people Lots of jobs available The pay is good Time for family Uses math/science/technology Amount of schooling required Improving society Work outdoors Job security</p><p>Please discuss the role you see for math/science in your future career. </p><p>Please describe any experiences you have working collaboratively with others in the last 2 years. </p><p>Please describe a societal problem or issue you would like to solve one day, and how you think it can be solved. </p><p>Please tell us any other reasons why we should consider you for participation in STEM Camp.</p><p>Revised 2/8/16 Camp registration cost is $75, due within two weeks of notification that you have been selected for participation. Thanks to our camp sponsors, we do have some funding available to provide need based camp scholarships. If you wish to be considered for a scholarship, please describe how you would like to make your case that a scholarship is needed. Examples of situations that justify the scholarship include qualification for free/reduced school through the National School Lunch Program, or having an immediate member who qualifies for a college Federal Pell Grant and who is your parent/guardian or a dependent of your parent/guardian.</p><p>For your application to be complete, we must also receive all of the following: 1. An academic transcript showing all middle school courses taken. 2. Three teacher recommendations using the official camp recommendation forms. Form 1 must be completed by a math or science teacher. Form 2 may be used for the other two recommendations. Please list the names of the people from whom you expect recommendations:</p><p>Name Subject taught or Email address position at the school</p><p>Before/After Hours Supervision: Camp hours are 8am-4pm Monday-Friday. Students should be dropped off between 7:45 and 8:00am, and picked up between 4:00 and 4:15pm. There is an extra charge of $25 per day for each day the student is picked up between 4:16pm and 5:15pm. There will be an additional charge of $5/minute for every minute the child stays past 5:15pm.</p><p>Parent signature required. By signing below, I agree that the information provided is complete and accurate. I understand that my child’s selection to participate requires his/her being there all day, every day, and I agree to abide by this requirement. I agree to pay additional charges required to cover damages caused by my child and to cover additional supervision charges as described in the above paragraph.</p><p>Signature:</p><p>Date: </p><p>Revised 2/8/16</p>