Summer 2024 Health Science Immersion Program (HSIP) Enrollment Request/ Application Form

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We are excited that you are interested in our Health Sciences Immersion Program (HSIP) taking place online this upcoming Summer! To apply, fill out this simple application requesting to enroll.

If you apply under Section Two before the priority deadline, we will return your decision within 3 - 4 working weekdays throughout the recruitment period in April and May. If you apply under Section One, we will return your final decision on or shortly before Thursday, May 23rd. You will receive your application response from our application email address (applications@impactinternships.org).

Summer 2024 HSIP will have 2 sessions, and the application decision will assign your final HSIP session time. Feel free to contact us at applications@impactinternships.org if you have any questions about this process.

Email *

Name: *

High School:

In which state is your high school located?

Current Grade Year (9 - 12)

9th Grade

10th Grade

11th Grade

12th Grade

Clear selection

Best Contact Phone Number:

Application Section/ Program Fee

Check Application Sections

Section One: Meet Family Income Guidelines for Free and Reduced Lunch Program (https://www.cde.ca.gov/ls/nu/rs/scales2223.asp)

Section Two: All Other Students (Program Fee)

Which Sessions Are You Available For?

Available

Session A: 11:00am PST - 2:00pm PST

Session B: 2:00pm PST - 5:00pm PST

Which time zone are you applying from?

Hawaiian Standard Time (HST) --- Session A: 8am to 11am / B – 11am to 2pm

Pacific Standard Time (PST) --- Session A: 11am to 2pm / B – 2pm to 5pm

Mountain Standard Time (MST) --- Session A: 12pm to 3pm / B – 3pm to 6pm

Central Standard Time (CST) --- Session A: 1pm to 4pm / B – 4pm to 7pm

Eastern Standard Time (EST) --- Session A: 2pm to 5pm / B – 5pm to 8pm

Clear selection

If You Are Available For Both Sessions - Which Would Be Your 1st Choice?

Session A

Session B

Short Response Prompt (1-2 Paragraphs): What are your current academic or personal interests (science or non-science) and what draws you to our Health Sciences Immersion Program? What do you hope to learn more about as a result of participating in our program?

Please select the range of your cumulative high school GPA below on a 4.0 scale. Feel free to use your weighted GPA if it is higher. We understand that every high school is different, and the GPA listed here is not an important factor in completing this form.

Below 2.5

2.50 to 2.99

3.00 to 3.25

3.25 to 3.49

3.5 to 3.99

Above 4.0

Clear selection

List Honors, AP, IB or Dual Enrollment courses you have completed or are currently completing in any subject below. We understand that different students have varying opportunities to take these types of courses at their individual high schools. This section can be left blank if you have not taken any so far.

Signature Statement: Do you attest that all information provided is accurate to the best of your knowledge? If applying as a Section One applicant, to the best of your knowledge, do you meet the family income qualification for the free and reduced lunch program?

Yes

Clear selection

Digital Signature: Type Name

A copy of your responses will be emailed to the address you provided.

Submit

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