NC State University FLAMES Outreach Application
This is the 2019-20 application for students who are interested in joining the FLAMES High School Outreach program at NCSU. Any questions should be emailed to flames.ncsu.outreach@gmail.com.

The FLAMES program is FREE OF CHARGE to all accepted students.

Applications are DUE BY: September 29th, 2019.
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Location and Dates for FLAMES
Sessions will be held on NC State’s Main campus at Poe Hall, 2310 Stinson Dr., Raleigh, NC 27695

Sessions are held from 10:00 am to 2:30 pm on Saturdays in the Fall:

-October 5
-October 19
-November 2
-November 16

Dates for the Spring will be announced later in the Fall.
Student First Name *
Student Last Name *
Student Email Address *
Current School *
for the 2019-2020 school year
Grade Level *
Date of Birth (month/day/year) *
(mm/dd/yyyy)
MM
/
DD
/
YYYY
Gender *
We ask for demographic information from applicants to ensure that our outreach serves a diverse group of students.
Race/Ethnicity *
We ask for demographic information from applicants to ensure that our outreach serves a diverse group of students.
Required
Has either parent graduated from a four-year college or university? *
We ask for demographic information from applicants to ensure that our outreach serves a diverse group of students.
Home Phone Number *
Please enter a phone number as (xxx) xxx-xxxx
Name of parent/guardian #1 *
E-mail address of parent/guardian #1 *
(please give an e-mail address that you check often)
Contact phone number of parent/guardian #1 *
Please enter a phone number as (xxx) xxx-xxxx
Name of parent/guardian #2
E-mail address of parent/guardian #2
(please give an e-mail address that you check often)
Contact phone number of parent/guardian #2
Please enter a phone number as (xxx) xxx-xxxx
Student's Career Interest *
Short Answer Prompt *
All students must submit a one-paragraph, student-written response describing how this program will benefit your academic future.  High school students' response should be a minimum of 50 words.
Please provide at least one additional emergency contact (other than parent/guardians). *
Please provide Name, Phone number, Relation for each contact listed
Are there any medical conditions, behavioral conditions, dietary restrictions or allergies instructors should be aware of? *
We will do our best to accommodate students' needs. We will not use this information to select applicants.
Which Saturdays can you commit to attending in the Fall? *
Required
As a part of the program, pictures may be taken and used for FLAMES related material including but not limited to: presentations at academic conferences, promotional materials, and take home souvenirs. Please indicate below whether you give consent to having the student's picture taken and used for FLAMES related materials and events. *
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