PCI NVA NSBE, Jr. Pre College Initiative Program

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "PCI NVA NSBE, Jr. Pre College Initiative Program"

Transcription

1 PCI NVA NSBE, Jr. Pre College Initiative Program Nubian Village Academy ational Society of Black Engineers Application Packet

2 NVA-NSBE, Jr. Pre-College Initiative WHAT IS NSBE, JR. PCI? NSBE, Jr.-PCI is an year round pre-college program hosted by Nubian Village Academy s National Society of Black Engineers. NSBE, Jr.-PCI is targeted towards 3rd 12th grade underrepresented students to provide encouragement, support, and assistance in their pursuit of a college education. The program s aim is to increase the number of underrepresented students who are prepared to enter college; moreover, qualified to pursue majors in engineering, math, science, and other technical disciplines. WHY JOIN NVA NSBE, JR. PCI? Exposure to collegiate life Hands-on activities and Fieldtrips In-depth look at STEM (Science, Technology, Engineering, and Mathematics) curriculums, and career opportunities Build leadership, gain professional experience Attend NSBE conferences, network with current and future engineers Do you plan to go to college or are you contemplating the possibility? Are you interested in engineering, math, science, or computers? If you answered yes! to any of these questions, then you may want to consider attending this annual pre-college program. NVA-NSBE, Jr. invites you to join our chapter. You will participate in a variety of hands-on engineering and science-related activities, as well as sessions designed to enhance your personal development and cultural awareness while interacting with students who share similar interests and goals. You will learn how to prepare for college and identify what courses to take during your high school years. In addition, participation in the program offers opportunities to become familiar with college-life at local Universities and its resources. WHO IS ELIGIBLE? NVA-NSBE,Jr.-PCI is designed for underrepresented students who will be in grades 3rd 12th. WHAT DOES NVA NSBE, JR. PCI INCLUDE? The program consists of 14 events, scheduled over the upcoming school year at Nubian Village Academy. The events include a variety of activities, fieldtrips, workshops, and seminars. Some fieldtrips may have additional fees associated. The Chapter meetings will take place on 2 nd & 4 th Sundays from 2:00p-4:00p throughout the school year. All students are expected to participate in all meetings and events. Tentative dates for the NVA- NSBE,Jr.- PCI fieldtrips will be posted on our website: Students are encouraged to participate over their full academic years.

3 WHAT SHOULD I BRING? Wear our chapter uniform: Navy blue bottom (no jeans), light blue shirt, (navy blue blazer & plaid tie can be order through the school). Please bring your own pencils, pens, paper, and other writing supplies. Students are welcome to bring snacks. A COMPLETE PCI APPLICATION PACKET CONSISTS OF WHAT? A. PCI Application form B. Parent Permission form C. Health Treatment Authorization and Medical forms D. Completed Student Questionnaire E. Chapter Dues $45 Applications must be turned in at Nubian Village Academy. Please send all materials in one packet. Participant will be notified of membership within 10 days. Please note that Incomplete Applications will not be considered.

4 NVA-NSBE, Jr. Pre-College Initiative PCI APPLICATION FORM A complete NVA-NSBE-PCI application packet consists of: A. PCI Application form B. Parent Permission form C. Health Treatment Authorization and Medical forms D. Completed Student Questionnaire E. Chapter Fees $45 Applications must be turned in to Nubian Village Academy. Please send all materials in one packet. Participant will be notified of your membership within 10 days. Please note that Incomplete Applications will not be considered. (Please print neatly) STUDENT PERSONAL INFORMATION: Name Male Female Last First Middle Student ID # Age Date of Birth / / Current School GPA Address Street Apt # City State Zip Code Home Phone # ( ) Student E mail

5 STUDENT PERSONAL INFORMATION: Do you have access to a computer at home? (Please check one) Do you have access to a computer at school? (Please check one) Yes No Yes No Do you plan to go to college? (Please check one) Yes No If you plan to go to college where do think you might attend? What do you think you will major in while in college? PARENT / LEGAL GUARDIAN INFORMATION: Name Daytime Phone # ( ) Place of Employment E mail CURRENT SCHOOL INFORMATION: Name Address Street City State Zip Code Grade Level for (Please circle one) 3 rd 4 th 5 th 6 th 7 th 8 th 9 th 10 th 11 th 12 th T shirt size: Name of Guidance Counselor E mail PLEASE RETURN TO Nubian Village Academy Attn: Nin Aseeya Ra-El NVA-NSBE, Jr Fendall Avenue Richmond, VA Applications are accepted year round.

6 NVA-NSBE, Jr. Pre-College Initiative PARENT PERMISSION FORM This is to certify that my son/daughter, Please print full name of applicant has my permission to participate in the Pre-College Initiative Program sponsored by Nubian Village Academy s National Society of Black Engineers, Jr. (NSBE,Jr.). In addition, this form is an indication that I will support my son/daughter while participating in this program and will ensure that my son/daughter has transportation to and from Nubian Village Academy and that he/she attends every scheduled event. PARENT / LEGAL GUARDIAN INFORMATION: Name Please print Relationship to Applicant Address Street Apt # City State Zip Code Home Phone # ( ) Work Phone # ( ) E mail Parent / Guardian s Signature Date Note: The parent/guardian s signature on this permission form is an indication that NSBE and Nubian Village Academy are not responsible for any liabilities that occur as a result of this event. The student may not participate in the program unless ALL information is filled in on each form and all the required forms submitted.

7 Throughout NVA-NSBE, Jr.-PCI, you will have the opportunity to use photography equipment as a tool for documenting activities. Participants have the option to determine whether they would like their image and/or statements to be included in any of the photographs and/or videos taken by themselves, staff, or other participants in the project. No media containing a participant s image or statements will be used for this program unless a participant and his/her parent/guardian provides permission for us to do so. Please choose one option: I hereby irrevocably grant and convey to Nubian Village Academy all rights, title and interest in and to record my name, image, voice, statements and/or writings including any and all photographic images and video or audio recordings made by Nubian Village Academy in connection with NVA-NSBE, Jr.-PCI. I further irrevocably grant to Nubian Village Academy, its advertisers, customers, agents, successors and assigns, unrestricted rights to use the above mentioned sound, still, or moving images in any medium, including posting on the Internet and World Wide Web, for educational, promotional, advertising, or other purposes without limitation consistent with the mission of the Academy. I agree that all intellectual property rights to the sound, still, or moving images belong to Nubian Village Academy. I voluntarily waive my rights to any royalties, proceeds or other benefits derived from such photographs or recordings. I hereby do NOT grant or convey to Nubian Village Academy, NSBE all rights, title and interest in and to record my name, image, voice, statements and/or writings including any and all photographic images and video or audio recordings made by Nubian Village Academy in connection with NVA-NSBE, Jr. -PCI. This release is effective on the date written below and will remain in effect indefinitely. If individual is less than eighteen (18) years of age, his/her parent or legal guardian must also sign below. Participant Name Participant Signature Date Parent/Legal Guardian Name Parent/Legal Guardian Signature Date

8 IMPORTANT: This form must be completed by the NVA-NSBE, Jr.-PCI participant s parent or legal guardian (P/G) and must be returned along with the acceptance packet in order to participate in the program. Please note that a P/G signature is required in four places on this form. Name Home Address Home Phone Cell Phone DISCLAIMER OF LIABILITY Nubian Village Academy, the Nation Society of Black Engineers, and the staff/volunteers of the Programs do not assume liability for any injuries incurred while attending the NVA-NSBE, Jr.-PCI Program. In consideration of my child s opportunity to participate in this program, I do hereby agree to hold the Nubian Village Academy and its employees harmless and free from any transaction and/or occurrence directly or indirectly associated with my child s participation in the NVA-NSBE,Jr.-PCI. *Signature of Parent/Guardian *Signature of Participant Emergency Release Consent to Emergency Aid & Transportation I hereby give permission that my child,, be given treatment by a staff member at Nubian Village Academy. I also give my permission for my child to be transported by car or ambulance to an emergency center for treatment, and I agree to hold Nubian Village Academy and its employees harmless. Parent s Signature Date Consent to Medical Care and Treatment In the event that I cannot be contacted immediately, medical or surgical treatment can be administered to my child in the case of an accident or emergency, as prescribed by a treating physician, and I hold Nubian Village Academy and its employees harmless. *Signature Of Parent/Guardian *Signature Of Participant

9 EMERGENCY CONTACTS: Mother /Legal Guardian Work Phone Cell Phone Home Phone Father /Legal Guardian Work Phone Cell Phone Home Phone INSURANCE INFORMATION: Please supply the following information concerning your family health insurance policy. Insurance Company Name Phone Number Policyholder s Name Policy Number Group Number Policyholder s Address Please return this form in your application packet.

10 We would like to know more about how you decided to apply and attend our program, as well as some of your thoughts about your future. Although we ask for your name, we will keep all of your answers confidential. Name: 1. How did you learn about NVA-NSBE, Jr.-PCI? Teacher/Counselor Extracurricular Program Internet Search High School Graduation Year: Nubian Village Academy Representative Word of mouth Other 2. To what extent did the following factors influence your decision to join NVA-NSBE, Jr,- PCI? Parents wanted me to attend Encouragement from teacher/guidance counselor Wanted to learn more about engineering Wanted to attend fieldtrips Wanted to know more about Nubian Village Academy Wanted to meet new people Wanted to help prepare myself for college Wanted to enhance my awareness of careers in Engineering Not at All 1 A Little 2 Moderately 3 Very Much 4 3. Were you familiar with Nubian Village Academy before you learned about this program? Yes No 4. Who is the greatest influence in helping you make your academic/career decisions? (Select one) School guidance counselor School math teacher School science teacher Relative (who) Other

11 5. From your present knowledge of engineering, what fields of Engineering (Eng) interest you the most? (Select all that apply) Aerospace Eng Computer Science Materials Science & Eng Biological Eng Electrical & Computer Eng Mechanical Engineering Biomedical Eng Engineering Physics Operations Research & Eng Chemical Eng Environmental Eng Science of Earth Systems Civil Eng Information Science, Systems & Technology Other 6. The highest level of education I plan to achieve is (check one): B.S. (Bachelors) M.S. (Masters) Ph.D. M.D. (Medical) Other professional degree 7. Please list any of your relatives who are engineers or scientists (For example, Suzy Smith Mom). 8. List other science/engineering programs or organizations you participate:

12 NVA-NSBE, Jr.-Pre-College Initiative PCI APPLICATION PACKET CHECK LIST PCI Application form Parent Permission form - Please have your parent/legal guardian completely fill out this form. Emergency Release and Medical forms - A treatment authorization and medical form is attached with this packet. We request that you have your parent/legal guardian fill out these forms. Student Questionnaire Chapter Dues: $45 PLEASE NOTE THAT ALL ITEMS ON THIS CHECK LIST MUST BE FULLY COMPLETED AND SUBMITTED FOR YOUR APPLICATION TO BE CONSIDERED PLEASE SEND APPLICATION PACKET TO Nubian Village Academy Attn: Nin Aseeya Ra-El NVA-NSBE, Jr Fendall Avenue Richmond, VA Applications are accepted year round FOR FURTHER INFORMATION NVA NSBE Website Nubian Village Academy (800) NSBE PCI Advisor: Nin Aseeya Ra El (804) Nubian Village Academy does not discriminate against employees, students, or applications on the basis of race, sex, disability, age, veteran status, national origin, religion, political affiliation, or sexual orientation.. Please feel free to duplicate this application packet

Enrollment Application 2014-2015

Enrollment Application 2014-2015 Enrollment Application 2014-2015 Student Name: Date: Current Grade Level: Current School: Date of College Track Presentation: Submit Application by: Checklist of items that must be returned to College

More information

STUDENT APPLICATION FORM 2015

STUDENT APPLICATION FORM 2015 Camp Information: STUDENT APPLICATION FORM 2015 July 5 - July 10 and July 12 - July 17, 2015 Engineering Your Place in Space The ExxonMobil Bernard Harris Summer Science Camp (EMBHSSC) is organized to

More information

Rowan University s Aim High Science and Technology Academy

Rowan University s Aim High Science and Technology Academy s Aim High Science and Technology Academy (residential) Summer Science and Technology Program for Rising Seniors (Current 11th Graders) July 5, 2015 - July 31, 2015 (Sunday-Friday) STUDENT APPLICATION

More information

2014 High School Police Academy Application Packet. Session 1: July 7 th 11 th Session 2: August 11 th 15 th

2014 High School Police Academy Application Packet. Session 1: July 7 th 11 th Session 2: August 11 th 15 th 2014 Application Packet Session 1: July 7 th 11 th Session 2: August 11 th 15 th The Charlotte-Mecklenburg Police Department is offering high school students in Mecklenburg County the opportunity to experience

More information

Any questions may be directed to Master Officer Jason Stone or Master Officer Matt Mellenberger (919) 362-8661

Any questions may be directed to Master Officer Jason Stone or Master Officer Matt Mellenberger (919) 362-8661 Thank you for your interest in the Apex Police Department Law Enforcement Explorer Program. Please complete the following steps so we are able to process your application. Fill out the application completely

More information

Sign-up students NOW!

Sign-up students NOW! Formally known as SEMAA MAA is a K-12 Hands-on, Minds-on STEM (Science, Technology, Engineering, and Mathematics) engagement at its best! Sign-up students NOW! Tri-C MAA offers fun STEM education activities

More information

HealthCareers. Discovery Camp. Post Acute Medical Specialty Hospital Corpus Christi, TX June 17 & 18, 2015. Application Packet

HealthCareers. Discovery Camp. Post Acute Medical Specialty Hospital Corpus Christi, TX June 17 & 18, 2015. Application Packet HealthCareers Discovery Camp Post Acute Medical Specialty Hospital Corpus Christi, TX June 17 & 18, 2015 Application Packet Personal Information Name: Address: City: State: Date of birth: ZIP code: Home

More information

100 BLACK MEN OF AMERICA, INC. 2015-2016 NATIONAL SCHOLARSHIP PROGRAM APPLICATION PACKET OVERVIEW

100 BLACK MEN OF AMERICA, INC. 2015-2016 NATIONAL SCHOLARSHIP PROGRAM APPLICATION PACKET OVERVIEW Page 1 of 5 100 BLACK MEN OF AMERICA, INC. 2015-2016 NATIONAL SCHOLARSHIP PROGRAM APPLICATION PACKET OVERVIEW Dear Applicant: The 100 Black Men of America, Inc. is committed to the growth and development

More information

Please note: Once your child leaves campus, he/she WILL NOT be allowed back on campus to participate in the after school program.

Please note: Once your child leaves campus, he/she WILL NOT be allowed back on campus to participate in the after school program. VALOR Before/After School Program School Year 2016-2017 Mar Vista Academy Enrollment Form and General Release for the Before/After School Program State and Federal Programs Student First Name Middle Name

More information

STUDENT APPLICATION FORM 2015

STUDENT APPLICATION FORM 2015 STUDENT APPLICATION FORM 2015 June 14-26, 2015 Biodiversity: The Spice of Life Camp Information: The ExxonMobil Bernard Harris Summer Science Camp (EMBHSSC) is organized to provide activities, experiments,

More information

Project Aerospace ACE Academy Application

Project Aerospace ACE Academy Application Project Aerospace ACE Academy Application Location: (s): The OBAP Aviation Career Education (ACE) Academy is designed to provide a more in-depth look at the aviation industry for students who truly want

More information

2013 Health Careers Summer Camp Application Checklist

2013 Health Careers Summer Camp Application Checklist 2013 Health Careers Summer Camp Application Checklist Please use this checklist to confirm that all required documents have been obtained and completed before mailing your complete application packet to

More information

Jacob s Ladder Pediatric Rehab Center: Respite Program Intake Packet Page 1 of 5. Respite Program:

Jacob s Ladder Pediatric Rehab Center: Respite Program Intake Packet Page 1 of 5. Respite Program: Jacob s Ladder Pediatric Rehab Center: Respite Program Intake Packet Page 1 of 5 Respite Program: Child s Name #1 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Child s Name #2 Age Birth

More information

Exploring Math and Science Academy (EMSA)

Exploring Math and Science Academy (EMSA) Student Name: 1 THE UNIVERSITY OF OKLAHOMA HEALTH SCIENCES CENTER (OUHSC) OFFICE OF COMMUNITY PARTNERSHIPS AND HEALTH POLICY A primary goal of the University of Oklahoma Health Sciences Center (OUHSC)

More information

Thursday, July 9th, 2015 and Friday, July 10th, 2015 from 7:30 AM to 5 PM

Thursday, July 9th, 2015 and Friday, July 10th, 2015 from 7:30 AM to 5 PM Dear Applicant to Nurse Academy and Parent/Guardian, Thank you for your interest in Nurse Academy 2015. Nurse Academy is designed for the student who is interested in exploring the profession of nursing

More information

Wesleyan Pre-College Access Program

Wesleyan Pre-College Access Program Wesleyan Pre-College Access Program What is the Pre-College Access Program? Wesleyan University s Pre-College Access Program is a comprehensive program developed to enhance the academic skills and preparation

More information

ANSEP SUMMER BRIDGE APPLICATION FORM 2015

ANSEP SUMMER BRIDGE APPLICATION FORM 2015 APPLICATION FORM 2015 What is the ANSEP Summer Bridge? The ANSEP Summer Bridge focuses on developing students academically, socially and professionally for college and careers. Summer Bridge students enroll

More information

UConn First Star Academy 2015 Application Checklist

UConn First Star Academy 2015 Application Checklist Student's Name: Social Worker: Area Office: Phone #: UConn First Star Academy 2015 Application Checklist Please use this checklist to make sure the application is complete: 1. Student Application 2. DCF

More information

STUDENT APPLICATION FORM 2013

STUDENT APPLICATION FORM 2013 STUDENT APPLICATION FORM 2013, June 16-21, 2013 & June 23-28, 2013 icreate: STEM Design for a Sustainable Future Camp Information: The ExxonMobil Bernard Harris Summer Science Camp (EMBHSSC) is organized

More information

STUDENT APPLICATION FORM 2014

STUDENT APPLICATION FORM 2014 STUDENT APPLICATION FORM 2014 July 12-23, 2014 Bridging the Gap in STEM Application Deadline: April 25, 2014 Camp Information: The ExxonMobil Bernard Harris Summer Science Camp (EMBHSSC) is organized to

More information

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR Welcome Child s Enrollment Form Parent Pick-Up Authorization Emergency Information, Waiver & Medical

More information

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes)

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes) Robert D. Fowler Family YMCA Middle School Enrichment Program Student Registration Form 2015-16 Ivy Prep Academy Program Hours: 7am-7:45am & 4pm-7pm Transportation AM: Group leaves at 7:30am Transportation

More information

Jacob s Ladder Pediatric Rehabilitation Center, Inc. Child Respite Program

Jacob s Ladder Pediatric Rehabilitation Center, Inc. Child Respite Program Page 1 of 5 Intake Sheet Child s Name #1 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Child s Name #2 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Father/Mother/Guardian:

More information

UPWARD BOUND. New Student Application

UPWARD BOUND. New Student Application Western Michigan University UPWARD BOUND New Student Application Federal TRiO Program Funded by the U.S. Department of Education Division of Multicultural Affairs Office of Diversity and Inclusion revised

More information

Summer@IMSA 2014 Program Schedule

Summer@IMSA 2014 Program Schedule Summer@IMSA 2014 Program Schedule Day Programs Grade Level Fall 2014 Program Name Cost Program Location 2014 Dates 3 rd 4 th Science Explorers, Jr. $260.00 Aurora June 9-13 3 rd 4 th Science Explorers,

More information

Souderton Area. Internship Contract

Souderton Area. Internship Contract Souderton Area S c h o o l D i s t r i c t Internship Contract Student Information Student s Name: Street Address: City: State: Zip: Home Phone: Cell Phone: Company Information Company Name: Location Address:

More information

U.S. Department of Education TRiO Programs Upward Bound Math and Science Fact Sheet (2015)

U.S. Department of Education TRiO Programs Upward Bound Math and Science Fact Sheet (2015) U.S. Department of Education TRiO Programs Upward Bound Math and Science Fact Sheet (2015) Program Description The Upward Bound Math and Science program is designed to strengthen the math and science skills

More information

All communications will be through email, so please be sure we have your email and your parent s email to avoid miscommunication.

All communications will be through email, so please be sure we have your email and your parent s email to avoid miscommunication. Volunteering as a Teen at St. Mary Note: We appreciate your attention to detail with concerns to completing this application. It is imperative that we be compliant with the various accreditation regulations

More information

APPLICATION CHECKLIST

APPLICATION CHECKLIST APPLICATION CHECKLIST Before submitting the application, please ensure that you have completed and provided the following: All appropriate boxes checked and blanks filled in on all pages. Signed photocopy

More information

Haven Virtual Academy Application Packet for Online School 2015-2016

Haven Virtual Academy Application Packet for Online School 2015-2016 Haven Virtual Academy Application Packet for Online School 2015-2016 Haven Virtual Academy (HVA) offers a unique learning environment for students who are eager to learn and are self-motivated. The Kansas

More information

Dear Corner Stone Charter Parent:

Dear Corner Stone Charter Parent: Dear Corner Stone Charter Parent: Welcome to Boll Family YMCA s School Age Child Care (SACC) program. We are looking forward to sharing the next 11 months with your child before and after school. Attached

More information

Community Service GRADUATION REQUIREMENT

Community Service GRADUATION REQUIREMENT 7/23/15 Community Service GRADUATION REQUIREMENT Beginning with Students Entering Grade 9 in 2013-2014 and Beyond Community Service Graduation Requirement Beginning with Students Entering Grade 9 in 2013-2014

More information

JUNE 20 24, 2016 VIDEO GAME DEVELOPMENT SUMMER CAMP

JUNE 20 24, 2016 VIDEO GAME DEVELOPMENT SUMMER CAMP Attention upcoming 7 th - 10 th graders: You are invited to join the IT and Web Design faculty at Carteret Community College for an action packed week of Video Game Design, Development, and Play. JUNE

More information

Big House 2015. Cost for the Trip $125 if turned in by March 29th $150 if turned in by April 26th $175 if still space in the camp after April 26th

Big House 2015. Cost for the Trip $125 if turned in by March 29th $150 if turned in by April 26th $175 if still space in the camp after April 26th Cost for the Trip $125 if turned in by March 29th $150 if turned in by April 26th $175 if still space in the camp after April 26th Big House 2015 June 11-14 Bellville, TX Big House is a summer mission

More information

Wallace Community College Dual Enrollment Program Application

Wallace Community College Dual Enrollment Program Application Wallace Community College Dual Enrollment Program Application Checksheet for Dual Enrollment Application Packet Application MUST BE COMPLETE or it will not be accepted for processing! USE A PEN NO PENCIL!

More information

DAVID H. PONITZ CAREER TECHNOLOGY CENTER. F r e shme n

DAVID H. PONITZ CAREER TECHNOLOGY CENTER. F r e shme n DAVID H. PONITZ CAREER TECHNOLOGY CENTER F r e shme n STUDENT ADMISSIONS PACKET Academic Year 2015-2016 Dear Prospective Student, Thank you for your interest in Dayton Public Schools Ponitz Career Technology

More information

Aspirnaut Summer Research Internship Program HIGH SCHOOL APPLICATION

Aspirnaut Summer Research Internship Program HIGH SCHOOL APPLICATION Aspirnaut Summer Research Internship Program HIGH SCHOOL APPLICATION Sunday, May 31 through Saturday, July 10, 2015 (6 weeks) Application Deadline: February 1, 2015 Program Description The Aspirnaut Program

More information

PARTICIPANT APPLICATION Page 1 of 3 Revised September 2015

PARTICIPANT APPLICATION Page 1 of 3 Revised September 2015 Page of 3 Revised September 05 Student Information Please print in BLACK or BLUE ink. Last Name First Name Middle Name Sex Male of Birth (mm/dd/yyyy) Student School ID # Social Security Number Female Current

More information

Application for Admission with Advanced Standing (for Year 3)

Application for Admission with Advanced Standing (for Year 3) Application, nonrefundable application free, letters of evaluation, transcripts, and course descriptions must submitted to our office no later than February 1. This application should be completed in legible

More information

Student Board of Directors Application Packet

Student Board of Directors Application Packet Dear Student, Thank you for your interest in participating in the Student Board of Directors Program at the Federal Reserve Bank of Kansas City, Denver Branch. Please complete this application packet,

More information

Boston Area Health Education Center

Boston Area Health Education Center Boston Area Health Education Center Youth to Health Careers Program Application Checklist Due March 12th, 2014 Full Name: School: Best Phone to Contact You: Grade: The Youth to Health Careers (Y 2 HC)

More information

CONTRACT. Southwest Tour. Arkansas and Texas

CONTRACT. Southwest Tour. Arkansas and Texas 27 th Annual Tour CONTRACT Southwest Tour Arkansas and Texas APRIL 3 rd April 10, 2016 COLLEGES and UNIVERSITIES (Tentative) Arkansas Baptist College, Huston-Tillotson University, Jarvis Christian College,

More information

Department of Psychology

Department of Psychology Department of Psychology Psychology Summer Enrichment Program Program Dates: May 19- June 27, 2014 Please send application, letters of recommendation and transcripts to: University of Detroit Mercy Doctoral

More information

PREP. Determined Leaders, Future Engineers. Dear Student,

PREP. Determined Leaders, Future Engineers. Dear Student, PREP Office of Engineering Studies Harold Washington Hall Room 129 9501 S. King Drive Tel 773-995-2357 Fax 773-995-4504 Determined Leaders, Future Engineers Dear Student, Thank you for your interest in

More information

Service Academy Nomination

Service Academy Nomination Service Academy Nomination Application Packet 2015-2016 Congresswoman Corrine Brown Attn: Jackie Gray Military Academy Program Director 101 East Union Street, Suite 202 Jacksonville, FL 32202 Phone 904-354-1652

More information

New Student Application 2015-2016

New Student Application 2015-2016 Davis Aerospace Technical High School Taking Education To A Higher Altitude New Student Application 2015-2016 Ian Diem, Director Paul Magee, Asst. Principal Stephanie Jenkins, Asst. Principal 900 Dickerson

More information

December 4, 2013. Dear Students:

December 4, 2013. Dear Students: Oklahoma School of Science and Mathematics Drumright Regional Center 3 Central Tech Circle Drumright, Oklahoma 74030 918-352-2551 December 4, 2013 Dear Students: The faculty of the Oklahoma School of Science

More information

Georgia Tech North Ave. NW Atlanta Ga. 30332

Georgia Tech North Ave. NW Atlanta Ga. 30332 Welcome to Fun Weird STEM Saturdays 2014 The functioning objective of Fun Weird Science STEM Saturdays is to: 1. Provide students with hands-on STEM experience; and 2. Engage students in the exciting ways

More information

Important Information Please keep this page for your records

Important Information Please keep this page for your records Camp Horizon Important Information Please keep this page for your records 1. Complete the enclosed application and the scholarship form thoroughly. Mail them immediately to the camp address listed below.

More information

Boston Area Health Education Center

Boston Area Health Education Center Boston Area Health Education Center Youth to Health Careers Program Full Name: School: Application Checklist Due March 16th, 2016 Best Phone to Contact You: Please Circle: Home Cell Grade: The Youth to

More information

STUDENT DATA SHEET. Student s Legal Last Name Legal First Name Middle Name Preferred Name. Student s Residence Street Address City State Zip Code

STUDENT DATA SHEET. Student s Legal Last Name Legal First Name Middle Name Preferred Name. Student s Residence Street Address City State Zip Code GRASSFIELD HIGH SCHOOL GOVERNOR S STEM ACADEMY APPLICATION Grassfield High School, 2007 Grizzly Trail, Chesapeake, VA 23323 Academy Coordinator: Karen Black 757-558-4493 Karen.Black@cpschools.com Application

More information

2014 CERET Renewable Energy Train the Trainer Academy Biofuels Education and Training June 23-27, 2014 James B. Dudley High School, Greensboro, NC

2014 CERET Renewable Energy Train the Trainer Academy Biofuels Education and Training June 23-27, 2014 James B. Dudley High School, Greensboro, NC 2014 CERET Renewable Energy Train the Trainer Academy Biofuels Education and Training June 23-27, 2014 James B. Dudley High School, Greensboro, NC Instructions By March 31, 2014, submit this application

More information

Tarrant County College South Campus Pre-freshman Engineering Program PREP 2011 - Year 1-4 Application

Tarrant County College South Campus Pre-freshman Engineering Program PREP 2011 - Year 1-4 Application Come to PREP and discover, learn, grow, make new friends, prepare for high school, experience college life, and explore possible careers. WHAT IS PREP? PREP is a mathematics-based, academic enrichment

More information

Thank you for your interest in volunteering at Trinitas Regional Medical Center.

Thank you for your interest in volunteering at Trinitas Regional Medical Center. Thank you for your interest in volunteering at Trinitas Regional Medical Center. Please be advised that each participant in the Trinitas Regional Medical Center Volunteer program must complete the following

More information

Bachelor of Science Nursing (RN to BSN)

Bachelor of Science Nursing (RN to BSN) Bachelor of Science Nursing (RN to BSN) Application Packet The Bachelor of Science in Nursing program (BSN) is accredited by the Commission on Collegiate Nursing Education (CCNE). Olympic College Mission

More information

COMMUNITY FOR NEW DIRECTION PARTICIPANT REGISTRATION FORM

COMMUNITY FOR NEW DIRECTION PARTICIPANT REGISTRATION FORM COMMUNITY FOR NEW DIRECTION PARTICIPANT REGISTRATION FORM Child s Name (Last) (First) (Middle Init.) Address Apt. # Zip Code Home Telephone Message Telephone Birth Age *Gender: Male Female *Race (please

More information

AETNA HPPI ACADEMY PROGRAMS APPLICATION

AETNA HPPI ACADEMY PROGRAMS APPLICATION AETNA HPPI ACADEMY PROGRAMS APPLICATION The Aetna Health Professions Partnership Initiative Academy Sponsored By: Uconn Health Department of Health Career Opportunity Programs Aetna Health Professions

More information

Professional Technical Teacher Education Bachelor of Applied Science Program

Professional Technical Teacher Education Bachelor of Applied Science Program Professional Technical Teacher Education Bachelor of Applied Science Program APPLICATION FOR ADMISSION FALL 2016 1 st Review Due Date: May 13, 2016 Applications received after the first review will be

More information

A M E 8 ( F I R S T, M I D D L E, FA M I LY/ L A S T N A M E

A M E 8 ( F I R S T, M I D D L E, FA M I LY/ L A S T N A M E Welcome! Apply online at www.hamlineinfo.org/online (and get your admission decision faster!) About You Or complete and mail in this form. See page 8 for our mailing address. FRESHMAN APPLICATION NAME

More information

Haven Virtual Academy Application Packet for Online School 2014-2015

Haven Virtual Academy Application Packet for Online School 2014-2015 Haven Virtual Academy Application Packet for Online School 2014-2015 Haven Virtual Academy (HVA) offers a unique learning environment for students who are eager to learn and are self-motivated. The Kansas

More information

Sustainable Building Science Technology

Sustainable Building Science Technology Sustainable Building Science Technology Bachelor of Applied Science Program APPLICATION FOR ADMISSION FALL 2016 1 st Review Due Date: May 13, 2016 Applications received after the first review will be accepted

More information

University of Illinois College of Veterinary Medicine Coordinated Degree Program Application Package Augustana College 2015

University of Illinois College of Veterinary Medicine Coordinated Degree Program Application Package Augustana College 2015 Augustana College and University of Illinois Coordinated Degree Program Baccalaureate of Arts/Doctorate of Veterinary Medicine (BA/DVM) (version 8/28/2015) Augustana College and the College of Veterinary

More information

2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION

2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we

More information

Ambassador Application

Ambassador Application Ambassador Application Dear Applicant, Thank you for your interest in Dallas Medical Center s Ambassador Program! Your willingness to invest a few hours each week is greatly appreciated. I believe you

More information

Educational Talent Search

Educational Talent Search Dear Parent(s), Educational Talent Search (ETS) is a project funded by the U. S. Department of Education and is administered by Diablo Valley College (DVC). The purpose of this project is to encourage

More information

Learning 2 Mastery After-School Reading and Math Program Parent Packet

Learning 2 Mastery After-School Reading and Math Program Parent Packet Parent Packet 700 Pelham Road North, Jacksonville AL 36265 Dear Parents! Welcome to a new and exciting time with the Learning 2 Mastery program. The hours of operation during the program are 3:15 p.m.

More information

Registration Form Penn State Weather Camp June 14 19, 2015 Penn State Advanced Weather Camp June 21 26, 2015

Registration Form Penn State Weather Camp June 14 19, 2015 Penn State Advanced Weather Camp June 21 26, 2015 Registration Form Penn State Weather Camp June 14 19, 2015 Penn State Advanced Weather Camp June 21 26, 2015 TO BE COMPLETED BY PARENT OR LEGAL GUARDIAN. Date of Program Please print in ink or type, and

More information

www.gondtc.com/scholarships.html

www.gondtc.com/scholarships.html FOUNDATION FOR RURAL SERVICE SCHOLARSHIP APPLICATION ***FRS Scholarships are due to NDTC no later than February 22, 2016*** The Foundation for Rural Service (FRS), in cooperation with the National Telecommunications

More information

Application for the 2016 High School Law Camp June 13th, 2016 July 1st, 2016

Application for the 2016 High School Law Camp June 13th, 2016 July 1st, 2016 Application for the 2016 High School Law Camp June 13th, 2016 July 1st, 2016 Sponsored by The Law School Preparation Institute at The University of Texas at El Paso LSPI HSLC Coordinator Alejandra Hobbs

More information

Application Form June 14-19, 2015 PLEASE fill out online (and print) or write neatly on all parts of the form.

Application Form June 14-19, 2015 PLEASE fill out online (and print) or write neatly on all parts of the form. Application Form June 14-19, 2015 PLEASE fill out online (and print) or write neatly on all parts of the form. Part 1: Student Information Name: Gender: M F Street Address: City: State: Zip: Home Phone:

More information

NATHAN M. WOLFE LAW ENFORCEMENT CADET ACADEMY Working Together Since 1973

NATHAN M. WOLFE LAW ENFORCEMENT CADET ACADEMY Working Together Since 1973 MARCH NATHAN M. WOLFE LAW ENFORCEMENT CADET ACADEMY Working Together Since 1973 APPLICATIONS DUE DATE: MAY 1, 2016 The Nathan M. Wolfe Law Enforcement Cadet Academy will be held at the South Carolina Criminal

More information

Tech Judo Open II Invitational Judo Tournament

Tech Judo Open II Invitational Judo Tournament Tech Judo Open II Invitational Judo Tournament USA Judo Sanction # 2015-12-02 Date: Sunday, February 15, 2015 Tournament Director: Clyde Worthen Tournament Coordinator: Leonardo Victoria Head Referee:

More information

International Student Application

International Student Application Admission Application Requirements To be considered for admission to Bates Technical College, please complete this application and submit the following, in English, to Laurie Arnold, International Student

More information

Montefiore s Health Opportunities Program (Monte-HOP) Summer Internship Program Application Deadline: April 17, 2015

Montefiore s Health Opportunities Program (Monte-HOP) Summer Internship Program Application Deadline: April 17, 2015 Montefiore s Health Opportunities Program (Monte-HOP) Summer Internship Program Application Deadline: April 17, 2015 Please read application package in its entirety. Program Description: The Montefiore

More information

Application La Vega Early College High School Application

Application La Vega Early College High School Application 2014 Application La Vega Early College High School Application LVISD 2015-2016 Application for Admission School Information In Spring, 2014, the La Vega Independent School District developed the La Vega

More information

VIRGINIA TRANSPORTATION CONSTRUCTION ALLIANCE

VIRGINIA TRANSPORTATION CONSTRUCTION ALLIANCE VIRGINIA TRANSPORTATION CONSTRUCTION ALLIANCE CONTRACTOR SCHOLARSHIP PROGRAM GUIDELINES The VTCA Contractor Scholarship is funded and supported by the Contractor membership of the Virginia Transportation

More information

Baylor Autism Resource Center Applied Behavior Analysis (ABA) Therapy Program

Baylor Autism Resource Center Applied Behavior Analysis (ABA) Therapy Program Baylor Autism Resource Center Applied Behavior Analysis (ABA) Therapy Program Please see the enclosed information and application for more information. The Baylor Autism Resource Center (BARC) Applied

More information

TOWN OF POUGHKEEPSIE POLICE DEPARTMENT

TOWN OF POUGHKEEPSIE POLICE DEPARTMENT TOWN OF POUGHKEEPSIE POLICE DEPARTMENT INFORMATION PACKET OVERVIEW The Town of Poughkeepsie Police Department is seeking to provide an innovative program for youth residing in the Town of Poughkeepsie.

More information

NORTH MAHARASHTRA UNIVERSITY, JALGAON. NMU-CCC Joint Degree Admission Announcement

NORTH MAHARASHTRA UNIVERSITY, JALGAON. NMU-CCC Joint Degree Admission Announcement NORTH MAHARASHTRA UNIVERSITY, JALGAON NMU-CCC Joint Degree Admission Announcement Applications are invited from the eligible candidates for 3 years Joint Bachelor Degree Programme between North Maharashtra

More information

Community House High School Programs Standing with families since 1969

Community House High School Programs Standing with families since 1969 Dear Parents/Guardians, Founded in 1969, Community House is devoted to standing with Princeton families by providing tools for academic success and social- emotional wellness through programs that bolster

More information

Interview Contact Information Please complete the following. This information will be used to contact you to schedule your child s interview.

Interview Contact Information Please complete the following. This information will be used to contact you to schedule your child s interview. Golden Triangle Early College High School Program Interview Contact Information Please complete the following. This information will be used to contact you to schedule your child s interview. Student Name

More information

The 2016 San Francisco Police Foundation High School Student Stipend Internship

The 2016 San Francisco Police Foundation High School Student Stipend Internship The 2016 San Francisco Police Foundation High School Student Stipend Internship SFPD Youth and Community Engagement Unit 1245 3 rd Street, 5 th Floor San Francisco, CA 94158 Officer Raphael Rockwell Email:

More information

City College of San Francisco Gateway to College Application for Admission

City College of San Francisco Gateway to College Application for Admission Please read the application carefully before completing. Print clearly in blue or black ink. Be sure to complete the entire application and required essays. Please bring your completed application with

More information

2015 Tournament Entry Form

2015 Tournament Entry Form Mississippi MS HIGH SCHOOL BASS NATION 2015 Tournament Entry Form ONE FORM PER TEAM Angler #1 Name: Event Location: Angler #2 Name: School Club Name: Team Advisor Name: Ph# Address: City: State: Zip Code:

More information

RONALD E. MCNAIR SCHOLARS PROGRAM APPLICATION

RONALD E. MCNAIR SCHOLARS PROGRAM APPLICATION RONALD E. MCNAIR SCHOLARS PROGRAM APPLICATION RONALD E. MCNAIR SCHOLARS PROGRAM 1011 HOYT HALL, EASTERN MICHIGAN UNIVERSITY YPSILANTI, MI 48197 / TEL. (734) 487-8240 Date Applying for program starting

More information

1. COMPLETE & SUBMIT YOUR APPLICATION

1. COMPLETE & SUBMIT YOUR APPLICATION Dear Prospective Young At Art Museum Teen Volunteer, YAA Teen Leadership Program Sponsored by American Express Charitable Fund Thank you for your interest in volunteering with Young At Art Museum. The

More information

YALE UNIVERSITY CITIZENS, THINKERS, WRITERS: REFLECTIONS ON CIVIC LIFE APPLICATION FOR SUMMER 2016

YALE UNIVERSITY CITIZENS, THINKERS, WRITERS: REFLECTIONS ON CIVIC LIFE APPLICATION FOR SUMMER 2016 NOTE: This application can also be completed online at http://humanities.yale.edu/apply APPLICANT INFORMATION First Name Last Name M.I. Street Address Apt/Unit # City State ZIP Code Student Cell Phone

More information

Are you applying as part of a faculty team (See Part D selection Criteria) Check One Yes No

Are you applying as part of a faculty team (See Part D selection Criteria) Check One Yes No 2015 CERET Renewable Energy Train the Trainer Academy Solar Electric (Photovoltaic) Education and Training July 20-24, 2015 at Solar Energy International, Paonia, CO Instructions By March 15, 2015, submit

More information

N.D. Hopkins Scholarship Application Administered by the Dallas Builders Association 2015 Spring Semester

N.D. Hopkins Scholarship Application Administered by the Dallas Builders Association 2015 Spring Semester N.D. Hopkins Scholarship Application Administered by the Dallas Builders Association 2015 Spring Semester Application RECEIPT Deadline: Monday, January 5, 2015 N.D. Hopkins was an Honored Life Director

More information

GBRA SCHOLARSHIP PROGRAM Information and Guidelines

GBRA SCHOLARSHIP PROGRAM Information and Guidelines GBRA SCHOLARSHIP PROGRAM Information and Guidelines INFORMATION The Guadalupe-Blanco River Authority has established the GBRA Scholarship Program to award scholarships to three deserving senior high school

More information

INTERNSHIP INFORMATIONAL LETTER TO PARENTS, STUDENTS AND INTERN SPONSORS

INTERNSHIP INFORMATIONAL LETTER TO PARENTS, STUDENTS AND INTERN SPONSORS Mrs. Bertrand, Internship Teacher, cbertrand@k12albemarle.org INTERNSHIP INFORMATIONAL LETTER TO PARENTS, STUDENTS AND INTERN SPONSORS Western Albemarle High School offers a wonderful opportunity for students

More information

DEADLINE FOR APPLICATIONS IS Friday, APRIL 1, 2016

DEADLINE FOR APPLICATIONS IS Friday, APRIL 1, 2016 ELIGIBILITY REQUIREMENTS: SELECT Federal Credit Union members (must be at least a High School Senior) wishing to pursue higher education or further their education for career advancement. Applicants must

More information

Who is eligible? You are, regardless of sex, race, nationality, or religion if:

Who is eligible? You are, regardless of sex, race, nationality, or religion if: Who is eligible? You are, regardless of sex, race, nationality, or religion if: You are a citizen of the United States You are in high school (entering grades 9-11) Neither parent graduated from a four-year

More information

C.I.L.T. Counselor in Leadership Training. Program

C.I.L.T. Counselor in Leadership Training. Program C.I.L.T. Counselor in Leadership Training Program C.I.L.T. Volunteer Program Commitment Level Options 9 Week Field Trip Camp: o 9 week commitment o Dates: June 6 August 5 o Full Day Shift, 8:00am 4:00pm

More information

Mott Community College Gateway to College

Mott Community College Gateway to College Mott Community College Gateway to College Application Package Fall 2014 Semester (Classes Begin: September 2, 2014-December 17, 2014) 709 N. Saginaw Street Flint, MI 48503 (810) 232-2690/762-5173 Address:

More information

APPLICATION INSTRUCTIONS

APPLICATION INSTRUCTIONS NAACP Scholarship Information Packet APPLICATION INSTRUCTIONS Application forms and required documents must be postmarked on or before the last Friday in the month of March. GENERAL INSTRUCTIONS: Please

More information

Enrollment Application

Enrollment Application Enrollment Application MVA: Leading the Way Based on your student(s) grade and applicable circumstances, complete one enrollment packet per student and review the information below to determine what you

More information

In order to facilitate your application, please follow these guidelines.

In order to facilitate your application, please follow these guidelines. Dear Student, Thank you for your interest in becoming a Junior Volunteer at Paoli Hospital. Enclosed please find an application and other important material. Junior Volunteers are vital to our Volunteer

More information

Diversity Student Summer Research Opportunity Program. June 6, 2014 August 1, 2014 PROGRAM DESCRIPTION

Diversity Student Summer Research Opportunity Program. June 6, 2014 August 1, 2014 PROGRAM DESCRIPTION Diversity Student Summer Research Opportunity Program June 6, 2014 August 1, 2014 PROGRAM DESCRIPTION Eligibility and Admission Requirements The Diversity Student Summer Research Opportunity Program is

More information

Chatham Community Center Fitness Room

Chatham Community Center Fitness Room Chatham Park & Recreation 702 Main Street Chatham, MA 02633 Telephone Fax (508) 945-5159 www.chathamcommunitycenter.com Fitness Room Hours of Operation: Monday Saturday 8:00 A.M. to 9:00 P.M. Sundays 1-5:00

More information