Application Form - STEM-Summer Enrichment Program (STEM-SEP) 1

Please provide your preferred t-shirt size based on standard ADULT MALE sizing.

Limited transportation may be provided in the Harrisburg and Lebanon area. Please choose the answer below that best describes your situation.

I may need help with a ride

How did you hear about STEM-SEP?

If Yes, provide details

Current high school overall GPA

Science (Math, physics, biology, etc.) courses & year taken in high school

Intended major or area of interest in college (if known)

Educational attainment of parents/guardians 1

Educational attainment of parents/guardians 2

Extracurricular activities in school (example – sports, choir, school newspaper)

Awards and/or honors (example – placing in academic competition, honor roll, etc.)

Community service activities (example – volunteering with homeless, tutoring younger students, etc.)

Short essay

In 300 to 500 words, explain why you are interested in attending this workshop.

I understand that, if selected, I am required to attend all workshop sessions

I hereby verify that all the information that I have provided on this application is true and accurate. My signature gives permission for the project personnel to review any academic records and any information pertaining to my eligibility for this workshop.

Signature of student

Sign above

Name of parent/guardian

Signature of parent/guardian

Sign above