2022 STEM Application

Full Name *

First Name Last Name

Student E-mail *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

US Citizen *

Yes No

(If naturalized, provide date)

Gender *

Male Female

Ethnicity *

Have you ever attended a previous NNOA STEM Event?

Yes No

Full Name of Parent/ Guardian *

First Name Last Name

Parent's E-mail

Parent's Best Contact Number *

Area Code Phone Number

Name of School *

School Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Current Grade *

8th grade 11th grade 9th grade 12th grade 10th grade

Graduation Year *

Proposed College Major

12th Graders Only

ACT/SAT Scores: Math

12th Graders Only

ACT/SAT Scores: English

12th Graders Only

Have you ever been a member of NJROTC, Sea Cadets, Junior Marines, etc: *

Yes No

From:

To:

Have you received an acceptance letter from a junior college or university for the Fall Semester 2022?

Yes No

If YES, what is the name of your college?

What is your selected field of study?

Have you been awarded any merit or need-based college scholarships?

Proposed Major

How did you hear about this event?

Please indicate Food Allergy? *

Type NONE if there aren't any

Do you have any medical/physical limitations that require special assistance?

SCHOLASTIC ACTIVITIES

EXTRACURRICULAR ACTIVITIES: Include NJROTC, Civil Air Patrol, school, church, scouts, and community organizations, etc. (May use additional page if necessary)

List Organization and Position Held *

List other activities not mentioned above. Include only those that involve leadership, responsibility, or community service. (May use additional pages if needed.)

What would you like to learn at the NNOA STEM Event?

Are you considering a career in:

U.S. Coast Guard U.S. Marine Corps U.S. Navy NOAA (National Oceanic and Atmospheric Administration) US Public Health Service MARAD (Maritime Administration)

PRIVACY ACT STATEMENT/ STATEMENT OF UNDERSTANDING

Routine purposes: The information provided will be used strictly for the purpose set forth above and if selected, it may be used to determine eligibility for scholarships. Disclosure of personal information is strictly voluntary and will not adversely affect the applicant providing the information.

PARENTAL CONSENT

I, (ENTER PARENT NAME BELOW) give my consent for my child’s participation in NNOA STEM event that will be held at site identified above. In exchange for the benefits that my child will receive by participating in this program I hereby voluntarily agree, on behalf of myself and my child, to assume all of the risks in connection with my child's attendance at and participation in the NNOA STEM event, and I agree to release NNOA, event site host and event partners from any and all liabilities and claims whatsoever arising out of ordinary negligence in connection with my child's attendance and participation in the aforementioned program. This event requires prolonged periods of walking and standing. I affirm that I have read and understood this document.

Parent Name

First Name Last Name

Parent Acknowledgement *

I accept statement

Student Acknowledgement *

I accept statement

MEDIA RELEASE

I hereby give my permission to photograph, film, videotape and/or make sound recordings of my child, to quote or publish statements of my child and to use such photographs, films, videotapes, sound recordings and/or other statements for educational and promotional/advertising materials and for other purposes specified below. I understand that my child may be identified in any photographs, news stories or publications that the aforementioned institutions consider appropriate for release to magazines, newspapers, the World Wide Web sites, and/or other publications. I further understand that any such photographs, films, videotapes, sound recordings and/or written works are the property of NNOA and that neither my child nor I am entitled to any compensation for or rights in these materials. I release these NNOA from all liability with respect to the matters covered by this release.

Parent Acknowledgement *

I accept statement

Student Acknowledgement *

I accept statement

RELEASE AND WAIVER OF LIABILITY

I hereby agree to hold harmless, and to release and forever discharge NNOA, U.S. Government, United States Navy, and United States Naval Academy (USNA) and all of its officers, agents, employees, and successors (hereafter referred to as “Parties") and assigns acting officially or otherwise, from any and all claims, actions, or causes of action, on account of any loss or damage to property, personal injury or death, whenever they may arise, including aggravation of any preexisting condition, suffered by me, whatever the cause, including those damages, injuries, or deaths resulting from any defect or any error, act, or omission of any agent, officer, employee, volunteer, or third party.

This hold harmless agreement covers, but is not limited to, any property damage, personal injury, or death occurring during or as a result of my tour of USNA, including, but not limited to, a tour of naval vessels and boats moored at the base, static displays of equipment and other demonstrations.

I also agree to fully indemnify the Parties for any property damage, personal injury, or death which I may cause through negligence, willful misconduct, or deliberate unauthorized use of any equipment or property belonging to Parties including all court costs and reasonable attorney’s fees. Further, I agree to fully indemnify the Parties for any and all costs associated with any medical treatment and/or emergency response I may require as a result of personal injury or death associated with the tour of Parties, or naval property. The right of indemnification shall inure to the benefit of all successors in interest and assigns of the Parties, and the corresponding burden shall rest with any successors or assigns of mine and all those parties subject to this agreement, whether now known to me or as yet unascertained.

DRESS CODE

In order to enhance a STEM educational environment and promote proper personal growth habits, a dress code has been established for the NNOA STEM event. The purpose of this code is to remove distractive, disruptive, and dangerous apparel from the environment. The code has been written not to infringe upon the individuality of the students. In adopting this code, NNOA hopes to create a clean, healthy, and safe environment that will be conducive to good order and beneficial to all students. Students should wear appropriate, clean non-disruptive clothing, and in keeping with that intent, students are required to comply with the following: 1. Sunglasses may not be worn in classrooms unless medical reasons exist. 2. No hats may be worn within the buildings – uncover when entering buildings. 3. No clothing that promotes alcohol, drugs, violence, profanity, or is obscene as that word is construed by the United States Supreme Court decisions shall be worn. 4. Shorts of Bermuda short length are acceptable. Students may only be exempted from the provisions of the dress code due to health or handicapping conditions.

STANDARDS OF CONDUCT

Students are encouraged to always engage with others in a respectful manner. Actions that interfere with or threaten the orderly conduct of STEM event functions, or violate the written policy of the U.S. Navy, campus or shipboard rules will be grounds for immediate dismissal from the event. This applies to all STEM event and associated activities. Students are expected to follow the direction of event leaders and volunteers, refrain from displays of affection in public, outburst of anger, aggressive acts, bullying and behaviors that create a hostile or disruptive environment.

I understand the above Code of Conduct requirements for participation in the NNOA STEM event. I understand that failure to comply with this Code of Conduct may result in dismissal.

Parent Acknowledgement for Release of Liability, Dress Code, Standards of Conduct *

I accept statement

Student Acknowledgement for Release of Liability, Dress Code, Standards of Conduct *

I accept statement

PARENT NAME (electronic signature) *

STUDENT NAME (electronic signature) *

Acknowledgement Date *

Month Day Year

Student Registration and Acknowledgements