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: ( ) Cell Phone: ( ) email Address: I am currently (as of April, 2015) a: Sophomore Junior Other High School: GPA: I am interested in applying to attend Xtreme IT! 2015. I certify that I will be available during the week of June 14-19, 2015 and that the information provided on this application is accurate. student s signature date Complete the reverse side of this form as well
You may use additional pages if necessary to answer these questions. 1. List the classes you are taking currently or have taken in the past that relate to computers, math and/or technology. (Computer experience is not required to attend, but preference will be given to students who do have experience.) 2. Discuss how you have interacted with computers outside of school? 3. What are your favorite classes (be as specific as possible)? 4. In what school organizations and activities are you involved? 5. In what other activities outside of school do you enjoy (sports, hobbies, etc.)?
6. What job or career would most interest you today? 7. Briefly explain why you want to attend Xtreme IT! 2015. 8. What else (if anything) should we know about you as we consider applicants for Xtreme IT! 2015?
Part 2: Parent/Guardian Approval and Permission I/We approve our son/daughter,, application to Xtreme IT! 2015. I/We understand the camp is being held June 14-19 and that our son/daughter will be available to participate during that week. I/We understand that other forms will require our attention and completion prior to camp attendance. * Do you intend to apply for the scholarship to cover camp fees? Yes No Regular tuition is $300; Early Applicants (received before March 16) Tuition is $250 (you need to complete Part 3 to apply for scholarships) Print Parent/Guardian Name(s): Address (if different from the student): Home Telephone Number (if different from student): ( ) email Address (if available): How might we reach you during the day, if necessary? Parent/Guardian Signature: Date: ALL applications must include a $50.00 refundable deposit check made out to UM-St. Louis. This will be returned if your child is not accepted or, if your child is accepted, at the end of the camp. Applications and recommendations must be returned no later than April 1, 2015* to: Xtreme IT! 2015 Attn: Karen Walsh Phone: 314.516.6267 Information Systems Area Fax: 314.516.6827 University of Missouri-St. Louis email: information_systems@umsl.edu One University Boulevard m/c 22 St. Louis, MO 63121-4400 Students will be notified no later than May 1 of the acceptance decision. * Applications received by March 16 are eligible for reduced tuition.
Part 3: Financial Aid Application (complete only if you apply for a scholarship) Amount of aid you are seeking: Student Financial Status Are you employed? Yes No Salary/Hourly Rate: Number of Hours: Employer Address City/State/Zip Parent 1 Financial Status Are you employed? Yes No Salary/Hourly Rate: Number of Hours: Employer Address City/State/Zip Parent 2 Financial Status Are you employed? Yes No Salary/Hourly Rate: Number of Hours: Employer Address City/State/Zip Please state your reason you are applying for the aid (scholarship): Signature of Student Signature of Parent (Guardian)
Part 4: Counselor or Teacher Recommendation has applied to participate in Xtreme IT! 2015, the Imagine IT! summer academy held at University of Missouri - St. Louis (UMSL), June 14-19, 2015. It is a five-day leadership program emphasizing careers in information systems and information technologies. Please comment on how you believe such a program would benefit this student. In addition, please comment on this student s attitude, aptitude and behavior. It is not necessary for students to already have extensive computer experience or skills (although preference will be given to the students who have experience. Counselor / Teacher Comments (use back or attach additional sheets if necessary): Counselor / Teacher Signature: Counselor / Teacher Name (print): Counselor / Teacher Position: School: Recommendations must be returned no later than April 1, 2015 to: Xtreme IT! 2015 Attn: Karen Walsh Phone: 314.516.6267 Information Systems Area Fax: 314.516.6827 University of Missouri-St. Louis email: information_systems@umsl.edu One University Boulevard m/c 22 St. Louis, MO 63121-4400