Summer Youth Scholars Program
Hispanic Center of Excellence Summer Youth Scholars program Summer 2022

Please note that the deadline is May 29, 2022 - all components of the application should be received by this date. Admissions is also on a rolling basis which means we may have selected all of our qualified applicants to join the program before the deadline.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Gender *
Personal Email (not school) *
Full Address (include street and city) *
Date of Birth *
MM
/
DD
/
YYYY
Did you receive the COVID 19- Vaccination *
Phone number *
Race *
Ethnicity *
Hispanic Origin (i.e. Mexican, Columbia, etc.) *
Are you considered a Limited English Proficiency (LEP) learner? *
School Name *
Current Grade *
Country of Birth *
Parent 1 Name *
Parent/Guardian Marital Status *
Parent 1 Address *
Parent 1 Email *
Parent 1 Phone Number *
Parent 1 Highest Level of Education *
Parent 2 Name
Parent 2 Address
Parent/Guardian Marital Status
Clear selection
Parent 2 Email
Parent 2 Phone Number
Parent 2 Highest Level of Education
Clear selection
School Counselor's Name *
School Counselor's Phone Number *
What Science Courses have you taken? *
Have you taken the PSAT or SAT? *
If yes, what was your total score? (enter 0 if you did not take) *
What was your score for Math? (enter 0 if you did not take) *
What was your score for Reading?(enter 0 if you did not take) *
What was your score for Writing?(enter 0 if you did not take) *
Have you participated in prior NJMS programs? If so please list *
Are you interested in a Health Science Career *
Emergency Contact Name *
Emergency Contact Phone Number *
Do you (the applicant) have any medical conditions? If so please list: *
Do you (the applicant) have any food allergies? If so, please advise: *
Email Program essay to sysp@njms.rutgers.edu 
In 2 pages, include information on personal attributes, future goals, reason for applying to this program, and what you plan to accomplish by participating. Personal statements must be written in English. Following a Pre-Screening, Selected Students will be interviewed before final acceptance into the program
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms