STEM STRONG SISTERS REGISTRATION

Your Name*

First NameLast Name

The STEM Strong Sisters program exposes students to black and brown, female professionals in STEM fields, and gives them vital knowledge and skills to explore and pursue STEM.

Students must qualify for Medicaid to participate.

For more information, contact us at 817-680-4650

or email us at admin@nogginfoundation.org

Please be aware that only a limited number of slots are available for this program. Once we reach capacity, any additional registrants will be placed on a waiting list.

Relationship to student:*

Your Email Address*

example@example.com

Your Mobile Number*

Please enter a valid phone number.

Mobile Carrier*

Students's Name*

First NameLast Name

STEM Strong Sister is a program exposing black and Hispanic girls to STEM. What is your child's ethnicity?

Black/African descentHispanic/LatinaMixed race

Student's Grade*

5th6th7th8th

Does your student have any allergies, special instructions, dietary restrictions, or special needs we need to know about? Please give a detailed explanation below. If none, please type NA below. *

Emergency Contact #1*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Emergency Contact #2

First NameLast Name

Phone Number

Please enter a valid phone number.

How did you hear about our program?

Proof confirming you qualify for Medicaid. Provide Medicaid information or your most recent tax return (2022 or 2023)

I understand that STEM Strong Sisters is a 12-month program and completion is required for participation. Program completion includes the following attendance: 30 math tutoring sessions (Virtual or in-home), at least 8 monthly meetings (3 must be on tour days), and the STEM Camp.

YesNo

NOTE: If your student is already enrolled in tutoring with Noggin, she will continue with her current tutor and attend her regularly scheduled sessions. Students not enrolled in tutoring will need to register separately.

I understand that the sessions and camp will be located in and around Mansfield, Arlington, and Grand Prairie and I am responsible for my child’s transportation to the locations. (Students will be dropped off at sessions).

YesNo

Thank you for completing the application. We look forward to {studentssName} becoming a STEM Strong Sister!