2022 RBTV STEM Journey Letter Of Interest

Thank you for your interest in the RBTV STEM Journey. The STEM Journey is a multi-year hands-on project-based learning experience designed to increase exposure and access to STEM while developing the next generation of STEM Leaders.

Take some time to go to our website and learn more about the program https://www.ronburtontrainingvillage.org/. In addition, here is a video you can watch: RBTV Overview Video

Please note initial eligibility requirements for entry beginning Fall 2022:

Young women between the ages of 11 – 17 years old.
You must be 11 years old on or before January 1, 2022.
You cannot be older than 17 years old on June 1, 2022.

If you do not fall within this age requirement, please do not complete the application as you do not meet the age requirements.

By filling out this form, you begin the RBTV STEM Journey admissions process for the 2022 – 2023 Program year. Please thoughtfully complete the form as it will be your first impression to RBTV.

If you have any questions, please contact stem@ronburtontrainingvillage.org.

Name *

First Name Middle Name Last Name

Please upload a photo of the applicant *

Address *

Street Address

Street Address Line 2

City State

Zip Code

Villager Phone Number *

Area Code Phone Number

Mobile Number

Birth Date *

Month Day Year

Student Email Address *

School You Attend in Fall 2022

What grade will you be going into Fall 2022-2023 *

6th 7th 8th 9th 10th 11th 12th

Shirt Size *

Youth L Youth XL Small Medium Large XLarge 2XLarge

Shorts Size *

Youth L Youth XL Small Medium Large XLarge 2XLarge

Shoe Size (adult women's sizing) *

Upload your most recent Report Card

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Ethnicity *

Asian Black or African American Hispanic/Latino Native American and Alaska Native Native Hawaiian and Other Pacific Islander White Declined to Repond

First Parent or Guardian *

First Name Last Name

E-mail *

Mobile Phone *

Area Code Phone Number

Are you on active duty in the military?

Yes No

Have you ever served in the military?

Yes No

Do you (as the applicant's parent) have a parent that has served in the military?

Yes No

Second Parent or Guardian Name (If applicable)

First Name Last Name

E-mail

Mobile Phone

Area Code Phone Number

Are you on active duty in the military?

Yes No

Have you ever served in the military?

Yes No

Do you (as the applicant's second parent) have a parent that has served in the military?

Yes No

Family Income Range (per year)

$1 - $25,700 $25,701 - $42,800 $42,801 - $68,500 $68,501 - $102,900 $102,901 and above

Tell us about yourself. *

Why do you wish to attend RBTV? *

In what way do you think RBTV will help you attain your goals? *

At the conclusion of RBTV, how do you hope the experience might impact your life? *

What extracurricular activities/organizations are you in? How will you balance them with the RBTV STEM Journey?

How did you first learn of RBTV?

If you learned of RBTV through a family member, friend, or other trusted person, please name that person.

How is this person connected to RBTV?

Based on your submission of this form, you will undergo a review and interview period. Following completion of that period, you will be assigned an advisor to assist you with the remaining elements of the admissions process. Final acceptances will be determined by Spring 2022. You will be notified via phone and email to being this process.

RBTV STEM JOURNEY

Student Information

Parent & Guardian Information

Interest Questions