Your Full Name *
Address *
Destination (City, State) *
County *
Parent/Guardian Name(s) *
Current Home Phone *
Parent(s) Work Phone *
Parent Email Address *
Date of Birth *
High school you plan to attend *
Your Email Address *
School you attend now *
Grade *
What is your ethnicity? * ---Asian AmericanBlack AmericanCaucasian AmericanHispanic AmericanNative AmericanOther/Mix
Teacher's Name *
Phone *
Email Address *
Who do you think had the MOST influence on whether you took science or math classes? * ---Brothers/sistersCounselorsFriendsI didTeachersParents/guardians
Do you like science? * ---YesNo
Why or why not? *
Do you like math? * ---YesNo
How confident are you about science? * ---Not confidentSometimes confidentUsually confidentVery confident
How confident are you about math? * ---Not confidentSometimes confidentUsually confidentVery confident
Complete the following sentences any way you want * When I do science I feel...
Complete the following sentences any way you want * When I do sports I feel...
Complete the following sentences any way you want * When I do math I feel...
Complete the following sentences any way you want * A girl has a right to...
Complete the following sentences any way you want. * A girl should always...
Can you think of a way science has improved your life? * Can you think of a way science has improved your life?
Do you know any scientists? * ---YesNo
Do you know any scientists? If yes, who?
Please describe what you think or see, when you think of a scientist. * Please describe what you think or see, when you think of a scientist.
Please describe what you think or see, when you think of oceanography. * Please describe what you think or see, when you think of oceanography.
Would you like to graduate from high school? * ---YesNo
Would you like to go to college? * ---YesNo
Do you feel that you know how to prepare for college? * ---YesNo
Have you made plans to attend college? * ---YesNo
How interested are you in having a job involving: Science * ---No interestMaybeInterestedVery interestedNever considered
How interested are you in having a job involving: Engineering * ---No interestMaybeInterestedVery interestedNever considered
How interested are you in having a job involving: Math * ---No interestMaybeInterestedVery interestedNever considered
How interested are you in having a job involving: Computers * ---No interestMaybeInterestedVery interestedNever considered
How interested are you in having a job involving: Teaching Science * ---No interestMaybeInterestedVery interestedNever considered
List three people you most admire and why? * List three people you most admire and why?
If your ultimate dream came true, what kind of job would you like to have when you become an adult and why? * If your ultimate dream came true, what kind of job would you like to have when you become an adult and why?
What kind of job do you realistically think you will have when you become an adult and why? * What kind of job do you realistically think you will have when you become an adult and why?
Are you a part of any clubs, organizations, or after school programs? * ---YesNo
If so, please list. If so, please list.
What are your special talents: athlete? musician? performer? artist? writer? anything! Please list * What are your special talents: athlete? musician? performer? artist? writer? anything! Please list
Have you held any leadership positions (school, church, community)? * ---YesNo
Do you have a religious preference? * ---YesNo
Please share an experience(s) that have influenced your feelings about science learning. * Please share an experience(s) that have influenced your feelings about science learning.
IN YOUR OWN WORDS, TELL US ABOUT YOURSELF. Please write COMPLETE SENTENCES and respond to all questions * IN YOUR OWN WORDS, TELL US ABOUT YOURSELF. Please write COMPLETE SENTENCES and respond to all questions. In 250-500 words share: a) five things that are most important to you in life and why, b) your hobbies and activities outside of school, c) your favorite classes in school, d) what you like to do outdoors, e) your favorite science memory (whether in or out of school), and f) finish by listing five words that best describe you.
TELL US WHY YOU WOULD LIKE TO COME TO CAMP THIS SUMMER (Please write COMPLETE SENTENCES and reply to all questions. * In 250-500 words, tell us about your a) interests in the camp, b) your level of commitment to learning and participating 100% in the camp, c) your expectations from the camp, and d) benefits/ strengths you bring to camp. Finish with what you want to gain from the camp experience and how will it benefit you?
**Important** If you are a parent or teacher, please click on the link in your email receipt and fill out the additional forms.
Use your mouse to sign.