STEM Registration

Please remember this email address as it will be used for future applications.
Applicant's Email*
Did you attend STEM Institute Fall 2022 Program?*

YesNo
Do you have an OSIS Number?*

YesNo
To auto populate data, enter your OSIS Number. Note: Not all Fields will populate.

Guardian Information

Guardian Information must be filled out by Guardian
Relationship*
Guardian E-mail*
example@example.com
Name*

Guardian First NameGuardian Last Name
Guardian Phone Number*
Occupation
Emergency Contact

Guardian AboveAdd new
Emergency Information
Relationship*
Emergency Contact Number*
Emergency Contact's Name*

First NameLast Name

Education Information
Current Grade*
SHSAT is only open to 6 and 7.
Only grade 6 placements are available at this moment. Grade 7 placements are full.
Select School Name*
Listed as: Name of School (Alphabetical order) - DBN. Home School is part of this list.
If Other, please enter school name *
Enter your School Name
School Address *
Enter your School Address
Your Guidance Counselor Name?
Your Guidance Counselor email address
example@example.com
Does the student have an IEP or 504 requiring accommodations?*

YesNo
Please specify IEP or 504 arrangements to provide special accommodations.*
Math Courses Taken:
Select the Math courses you have completed*

Algebra IAlgebra IIGeometryNone of the above
Please indicate your Numerical Grade or Transcript Avg for Algebra I. *
If Received a Pass/ Fail Grade = Enter 0.10 for PASS and 0.50 for FAIL
Please indicate your Numerical Grade or Transcript Avg for Algebra II. *
If Received a Pass/ Fail Grade = Enter 0.10 for PASS and 0.50 for FAIL
Please indicate your Numerical Grade or Transcript Avg for Geometry. *
If Received a Pass/ Fail Grade = Enter 0.10 for PASS and 0.50 for FAIL

🚨IMPORTANT DATES TO KNOW🚨

Orientation Details

SHSAT Test Prep

Saturday, Feb 11, 2023

12:00PM - 2:00PM

In Person at City College

Parental Permission

I hereby give my approval for my child’s participation in any and all activities prepared by STEM Institute during the Online or In-Person STEM Institute program.
*Proof of Covid-19 Vaccination will be required for In-Person Classes*

Media Release and Authorization

I hereby consent for my child to participate in interviews, photographs, and videos for educational purposes. I also grant the STEM Institute & Partnership Organizations, the right to edit, use and reuse such products for non-profit purposes including use in print, on the internet and all other forms of media. I also hereby release the New York City Department of Education and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

Grade Release Authorization:

By signing below I grant permission for the STEM Institute to obtain and release academic information about my child if requested by the DOE (Department of Education). I understand this waiver will be in effect until the scholar is no longer an active student member of the STEM Institute, and will be on file for a minimum of 1 year after program participation.

BY ACKNOWLEDGING AND PLACING MY INITIALS BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Guardian Initials*
Parent Consent Signature
How did you hear about us?*

SchoolFriend/FamilyFacebookInstagramFlyerInternet SearchOther
Should be Empty:

SHSAT Test Prep Dates
Orientation:	Feb 11, 2023 - In Person at CCNY	12:00PM - 1:30:00PM
Session I:	March 4, 2023 - June 3, 2023	Saturdays 10:00AM - 2:00PM (Tutoring 1:00PM - 2:00PM)
Session II:	July 6, 2023 - August 11th, 2023	Mondays - Thursdays 9:00 AM - 12:00 PM & Optional 1:00 PM - 4:00PM (After School Summer Engagement Program)
Session III:	September 16, 2023 - October 21, 2023 + Additional Reviews if Exam is delayed.	Saturdays 10:00AM - 2:00PM (Tutoring 1:00PM - 2:00PM)

Admin

Guardian Information