Student Parent Form

Student Information Section

Student Name: (required)

Contact Email Address: (required)

Student School ID Number:

Parent Name: (required)

Street Address:

City:

State:

Zip:

Current Grade In School: ---5th6th7th8th

School Attending Next Year:

Birth Date: ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 ---19951996199719981999200020012002200320042005200620072008200920102011

Birthplace (city/state/country):

Gender: ---FemaleMale

T-Shirt Size: ---Youth SYouth MYouth LAdult SAdult MAdult LAdult XL

Which Program Are You Applying For? You CAN Do Multiple Weeks

STEM Institute Week One June 4-8th:  Full Day Half Day

STEM Summer Institute Week Two June 11-15th:  Full Day Half Day

STEM Summer Institute Both Weeks June 4-15th:  Both Weeks

STEM High School Program Week Two June 11-15th:  Full Day Half Day

If you are interested in 2 weeks and you need to mix 1/2 day and full days please email Susan at ssalz@psdschools.org

Oceanography Institute - Full Day June 4-8th:  Full Day

Oceanography Institute - Full Day June 11-15th:  Full Day

Pingree Park - June 11-15th (this is a sleep away camp):  June 6-10th

Oceanography California July 16th-20th:  July 16th-20th

Science of Entertainment California July 23rd-27th:  July 23rd-27th

Anthropology/Archeology of the Southwest July 30th- August 3rd:  July 30th-August 3rd

STEM students will remain on the Preston campus except for related outside activities. Parents and family members are invited to join us for the closing activities.

Student Questionnaire Section

Please list any academic enrichment or extracurricular programs (hobbies, sports, clubs, etc.) in which you have participated during the summer or academic year. Please note if you received any honors or awards.

Summer Programs You Have Attended - Include Year

Extracurricular Activities - Include Year

Check all of the following subjects that you have completed or are currently enrolled in.

Middle School Courses:
 5th Grade Math 5th Grade Science Connected Math 1
 6th Grade Math 6th Grade Science Connected Math 2
 7th Grade Math 7th Grade Science Connected Math 3
 Algebra, 1st year Algebra, 2nd year Geometry Computer Programming
Other Science

1. What made you want to apply to the STEM Program?

2. Why are you interested in studying science, technology, engineering and mathematics?

3. What would you like to be when you grow up? Why?

4. What is your strongest ability - what do you do best?

5. What have you done in school or in the community that you consider outstanding?

6. What one idea do you particularly like to discuss - that is, what subject always triggers your interest and excites you?

7. What is your best quality - your finest characteristic?

Parent Questionnaire Section

Please help us get to know your child by answering the following questions.

1. Has your child ever been recommended for any other gifted programs? If so, please explain.

2. Why do you want your child to attend this program?

3. What three adjectives would you use to describe your child?

4. What other information would you like for us to know concerning your child?

Please review the information entered and press the SUBMIT button below.