STEP at Old Westbury 2022-2023 Application

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If you have any questions please contact us at step@oldwestbury.edu. Please note a NYS Education Department Grant Regulation: By submitting this form you agree that if you are accepted as a participant of SUNY Old Westbury Science & Technology Program (STEP), you will not be a participant of a STEP on a different campus from July 2022- June 2023

Student First Name *

Student Middle Initial *

Student Last Name *

Name that you would like to be addressed by:

Please provide pronouns

Student Address (House # & Street) *

City, State, Zip Code *

Student Date of Birth *

YYYY

Student Grade for 2022-2023 school year *

Student Gender *

Male

Female

Non-binary

Student Ethnicity/ Race (Please select all that apply) *

Hispanic/ Latino

Black/ African American (Includes individuals of African descent)

Native Hawaiian/ Pacific Islander

Native American/ Native Alaskan

White

Asian

Required

Name of School for 2022-2023 year *

If your school was not on the previous list please give us the full name of your school, school address and school telephone #.

Are you eligible for a free or reduced priced lunch at school? *

Yes

Does student have any allergies or special needs? *

Has student participated in STEP before? If so what campus & year? *

To the best of my knowledge I meet the following eligibility requirements. Please check all that apply: *

My final gpa for the 2021-2022 school year is a 70 or above

I have lived in New York State for at least 1 year

Required

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