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Girls in Science Club 2020-21 Application
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* Indicates required question
Student Name: Last, First
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Your answer
Student Age
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Your answer
Student Date of Birth:
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MM
/
DD
/
YYYY
Grade Level
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6th
7th
8th
Parent/Guardian(s) Name:
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Your answer
Parent/Guardian Email:
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Your answer
Primary Telephone Number:
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Your answer
Alternate Contact Parent/Guardian
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Your answer
Alternate Contact Telephone Number:
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Your answer
Are you in Primetime?
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Yes
No
Did you fill out the Roosevelt After School Enrichment (ASE) club application? If not, fill out the application here:
https://friendsofroosevelt.org/programs/ase/ase-application/
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Yes
No
Are you a New Applicant or Returning Applicant?
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New Applicant
Returning Applicant
NEW APPLICANTS: Please tell us why do you want to be a part of the Girls in Science program? RETURNING APPLICANTS: Please tell us why you want to continue with the program?
*
Your answer
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