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Student Application - EMPOWER
Engaging Multidisciplinary Professional Opportunities for Women in Environmental Research
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* Indicates required question
Email
*
Your email
How old are you?
16 years old
17 years old
18 years old
Other:
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Student Name
*
First, M.I., Last
Your answer
Do you have access to a laptop, desktop computer or iPad?
*
Yes
No
Maybe
Do you have reliable access to internet?
*
Yes
No
Maybe
Are you able to attend in-person and virtual sessions all 4 weeks? (Note: Camp runs from June 3rd-June 28th)
Yes
No
Maybe
Clear selection
What is your address?
*
Your answer
What city do you live in?
*
Your answer
What state do you live in?
*
Your answer
What is your zip code?
*
Your answer
What is your phone number?
*
Please include area code.
Your answer
What school do you currently attend?
*
Your answer
What grade will you be entering for the 2024-2025 school year?
*
11th
12th
Other:
Required
Science Courses Taken
Select all that apply.
Biology
Chemistry
Physics
Anatomy
Other Science
General
Honors
AP
IB
Biology
Chemistry
Physics
Anatomy
Other Science
General
Honors
AP
IB
If "Other Science", which science was taken?
Your answer
T-Shirt Size
*
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult 2X-Large
Parent/Guardian Name
*
First Last
Your answer
Relationship to Student
*
Your answer
Parent's Phone Number and Email Address
*
Your answer
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