LAB IN A BOX Virtual Summer Camp
A 3 week intensive STEM camp including instruction and lab projects (All Virtual).  If all available spots are full, you will be placed on the waiting list.
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Last Name *
First Name *
What is your email address? *
What is your home address? *
What City do you live in? *
What is your Zip Code *
What is your phone number? *
Grade Level (Fall 2021) *
Date of Birth *
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T-Shirt Size? *
What school will you attend fall 2021? *
What school district is this school in? *
What part of STEM are you most interested in? *
What math have you completed? Select All that apply *
필수
Which science classes have you completed? Select all that apply *
필수
Please list your top 5 career choices *
Please list your top 5 college choices *
Parent Name *
Parent Email *
Parent Cell Phone Number *
Name of Emergency Contact *
Emergency Contact Phone Number *
I understand that my signature and my parent/guardian signature authorize STEM BRIDGES Houston representatives and/or the news media to photograph, videotape, audiotape, duplicate and transfer to any present or future technology their images while they are scholars, featured subjects or participants in STEM BRIDGES Houston programs.   Authorized agents and news media may use the photographs, videotapes, and audiotapes as appropriate to promote the STEM BRIDGES Houston and related programs.    No compensation will be paid for this use.  I certify that the information reported on this application is true, complete, and accurate to the best of my knowledge.       *
I understand that my signature and my parent/guardian signature means that I will actively participate each week in the LAB in a Box Virtual Summer Camp paid for by the University of St. Thomas Minority Science and Engineering Improvement Program funded by the United States Department of Education.                           *
I understand that I will receive a stipend at the end of my participation in the virtual summer camp (Additional information may be requested to process stipend payment, i.e. social security number) *
I was recommended for the camp by_________________ (Please write full name) *
Student Electronic Signature *
Parent Electronic Signature *
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