Home Education Pre-college Programs Adventures in STEM Camp

2018 Application for Adventures in STEM Camp

Student's Name *
Student's Date of Birth (MM/DD/YYYY) *
Address *
City *
Incoming Grade Level *	6th Grade 7th Grade 8th Grade
School *
Ethnicity
Race	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Accommodations Needed for Disability
Dietary Restrictions
Additional Allergies or Conditions
Parent/Guardian's Name *
Parent/Guardian's Phone Number *
Parent/Guardian's Email Address *
Additional Emergency Contact *
Request for fee reduction	No Yes
Student's Shirt Size (ie Youth Medium) *
Child or parent specific needs/requests can be entered here:

CURENT