GABBR LSAMP 2022 Summer Academy Application Form

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The 2022 Summer STEM Academy will take place from Tuesday, May 31 - Thursday, June 30 and is open to students who will have completed grades 7 - 10. Please complete the application form below as soon as possible.

First name: *

Last name: *

What grade will you be finishing in May 2022? *

6th

7th

8th

9th

10th

11th

In which county do you currently attend school? *

Barbour

Bullock

Butler

Conecuh

Dallas

Elmore

Lowndes

Macon

Montgomery

Pike

Russell

Sumter

Other:

What is the name of the school you currently attend? *

Current GPA: *

Home mailing address: (Street, City, State, ZIP) *

Student's E-mail address: *

Anticipated career or college major: *

In the space below, please write a few sentences about why you want to attend the 2021 Summer Academy. *

Parent's name: *

Parent's phone number: *

Parent's e-mail address: *

Race/Ethnicity: (select all that apply)

Asian

Black or African-American

Hispanic or Latino/a

Native Hawaiian or Pacific Islander

Native American or Alaska Native

White

Decline to Answer

Gender:

Male

Female

Decline to Answer

Clear selection

Do you have any type of documented disability?

Yes

Decline to Answer

Clear selection

Submit

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