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STEM Application Form 2021-2022
Section 1 - Student Information
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* Indicates required question
Email
*
Your email
First Name:
*
Your answer
Middle Name:
*
Your answer
Last Name:
*
Your answer
Current Middle School or High School:
*
Choose
Austintown
Boardman
Campbell
Canfield
Chaney
Columbiana
Crestview
East
Jackson-Milton
Labrae
Lowellville
McDonald
Poland
Sebring
South Range
Springfield
Struthers
United
West Branch
Western Reserve
Valley STEM
Other School
If student attends "Other School" what is the name of the school your student attends?
Your answer
What school district do you live in (district of residency)?
*
Your answer
What will be your Grade Level for the 2022-2023 School Year?
*
9
10
Date of Birth
*
MM
/
DD
/
YYYY
Gender
Female
Male
Prefer not to say
Other:
Clear selection
Is English your first language?
*
Yes
No
T-Shirt Size
*
XS
S
M
L
XL
XXL
How did you hear about us?
*
Choose
Recruitment Presentation
Friends
Parents
Counselors/Teachers/Administrators
Social Media
Advertisements
Next
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