STEM Literacy Winter 2022 Program Application

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Thank you for your interest in registering your child for the STEMSci Afterschool Program! Please start by providing an email address that we can contact you with for further information about the program. Then, fill out the application with your child's information below and we will get back to you shortly.

Email *

Today's Date

YYYY

Child's first and last name *

Preferred name (if applicable)

Birthdate (MM/DD/YYYY) *

Preferred gender pronoun

Female

Male

Prefer not to say

Other:

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Current school *

Current grade of enrollment (2nd, 3rd... etc) *

Does your child have allergies? If yes, to what? *

Is your child on any medication? *

Which subject is most interesting for your child? *

Science

Engineering

Technology

Other

Was your child absent more than 20 days in the last school year? *

Yes

Does your child qualify for an individual education plan (IEP)? *

Yes

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