APPLICATION (DUE TUESDAY APRIL 15TH, 2014) Math + Science + Leadership = The MSL Program

Transcription

1 APPLICATION (DUE TUESDAY APRIL 15TH, 2014) UW Tacoma Institute of Technology and Student Transition Programs Math + Science + Leadership = The MSL Program University of Washington Tacoma Summer Session July 7 25, 2014 Monday Friday, 8:30 a.m. 3:30 p.m. Graduation Ceremony & Celebration Friday, July 25 h 2 to 4 p.m. The mission of MSL is to encourage, motivate, and inspire students to succeed in science, technology, engineering, mathematics (STEM) and develop the leadership and academic skills necessary to pursue a career in these fields. The program supports successful transitions from middle school to high school and high school to college for all admitted students and their families. The program s mission is accomplished by offering: a fun but academically rigorous three week summer session; opportunities to build connections to other youth interested in STEM; mentoring by professional scientists and engineers; STEM based projects and field trips; monthly events to support access to college; If you are currently in 6 th through 11 th grade, then apply today to be considered for a free one year membership that includes access to all of the above opportunities, resources, and more! Submit your completed application to msluwt@uw.edu. by mail: in person: by The MSL Program MAT 106 msluwt@uw.edu University of Washington Tacoma 1900 Commerce Street # Tacoma, WA Questions? Contact Student Transition Programs msluwt@uw.edu

2 APPLICATION DEADLINE: Tuesday, April 15th, 2014 *** A complete application includes: Sections 1 4 *** 1. STUDENT INFORMATION To be completed by parents/guardians please write clearly Name of student: Address: Street and number apartment number ( ) City State Zip Home Phone Student School Name: Grade next school year ( ): 6 O 7 O 8 O 9 O 10 O 11 O Student s Date of Birth: Do you, or would you, qualify for any of the following programs: O Free Lunch O Reduced price Lunch O Regular Lunch O I don t know O Other (please specify): How were you referred to The MSL Program: O Past Participant [specify what year(s)]: O School (specify which school) : O Boys and Girls Club of America O Peace Community Center O Tacoma MESA O Other (please specify): Highest school level parents/guardians completed: O Less than high school O High School O 2 year College Degree O 4 year College Degree O Master s Degree or beyond O Other: Student Gender*: O Male O Female O Other Race and Ethnicity (Please mark all that apply)* O Caucasian O African American O American Indian/Alaskan Native O Asian O Hawaiian Native or other Pacific Islander O Hispanic/Latino O Other: *All requests for demographic information are voluntary.

3 2. PARENT/GUARDIAN INFORMATION To be completed by parents/guardians please write clearly Parent/Guardian Name (Primary contact for MSL): Phone: What other activities does your student participate in during the summer (from the end of one school year until the beginning of the next)? Please list activities (i.e., sports, academic programs, summer school, etc.) and date(s). How do you see this program benefiting your student and his or her potential successes? The MSL Program is strengthened by family involvement and interest. How do you see being involved with the program (i.e., daily conversations with the student, volunteering at lunch, participating in parent advisory board, etc.)? My signature indicates that I approve of my child s application to this program and understand that, if accepted, attendance is extremely important. I understand that if my student is absent more than four days during the summer program, then they may be dismissed from the program. Parent/Guardian Signature: Date: Additional forms to be completed upon acceptance into the program.

4 3. STUDENT ESSAY To be completed by students please write clearly Students must complete original responses to the questions below in one of the following formats: Essay (i.e., thesis statement, body, etc.) between 500 and 750 words in length. Art (Painting, drawing, or other rendering that addresses the below questions.) New applicants Students who have never attended The MSL Program should provide responses to questions 1 and 2 below. (only answer a total of two questions) Question 1: Describe an activity or an organization in which you were involved this past school year. To what extent are you a leader in this setting? What do you believe is the number one quality of a leader and why? Question 2: To what extent do you see math, science, technology and/or leadership playing a role in your future academic goals? For returning students Students who have attended The MSL Program should provide one responses for questions 3 and one response for 4 below. (only answer a total of two questions) Question 3A: Describe an activity or an organization in which you were involved this past school year. To what extent are you a leader in this setting? What do you believe is the number one quality of a leader and why? OR Question 3B: To what extent do you see math, science, technology and/or leadershi playing a role in your future academic goals? AND Question 4: To what extent has The MSL Program impacted your life? In other words, how are you different as a result of being in the program? Why are you interested in returning? Responses that do not follow the guidelines outlines above will not be considered for admittance to the program.

5 4. STUDENT REFERENCE (1 OF 2) Students should provide two references that will be submitted with the program application. References should not be immediate family members and at least one reference should be from a teacher or school administrator. Thank you for answering all of the following recommendation questions. Your responses will help us in choosing students to participate in the MSL Program 2014 at UW Tacoma. Please note that the application deadline for students and families is Tuesday, April 15th. Applicant Name: Applicant Grade How long have you known this applicant? What is your relationship to the applicant? Would you recommend this student for The MSL Summer Program? O Strongly recommended O Not recommended O Recommended O Unable to respond O Recommended with reservations Please indicate how you would rate the applicant by marking one appropriate space for each area. Area Not Applicable/ Unable To Respond Below Above Outstanding Academic achievement Commitment to learning Leadership qualities Ability to work in a team Written communication Oral Communication Are there any additional qualities this student possesses that we should be aware of? Reference name (Print): Signature: Reference

6 4. STUDENT REFERENCE (2 OF 2) Students should provide two references that will be submitted with the program application. References should be immediate family members and at least one reference should be from a teacher or school administrator. Thank you for answering all of the following recommendation questions. Your responses will help us in choosing students to participate in The MSL 2014 Program at UW Tacoma. Please note that the application deadline for students and families is Tuesday, April 15th. Applicant Name: Applicant Grade How long have you known this applicant? What is your relationship to the applicant? Would you recommend this student for The MSL Summer Program? O Strongly recommended O Not recommended O Recommended O Unable to respond O Recommended with reservations Please indicate how you would rate the applicant by marking one appropriate space for each area. Area Not Applicable/ Unable To Respond Below Above Outstanding Academic achievement Commitment to learning Leadership qualities Ability to work in a team Written communication Oral Communication Are there any additional qualities this student possesses that we should be aware of? Reference name (Print): Signature: Reference