SSRC Application Form

SSRC Application Form

Fill out this form to apply for the Southside Robotics Club (SSRC) hosted at the LCDA in partnership with the Professional Chapter of Society of Professional Engineers (SHPE).
The Southside Robotics Club (SSRC) will be participating in the FTC Challenge from FIRST, with a team size limited to 15-20 students from 7th-12th grade, based on mentor availability. Parental involvement is encouraged, and there are numerous ways to assist, even without prior experience.

SSRC meets 2-4 hours each week from September-March, excluding holidays. Students are encouraged to meet outside of the set meeting times.

All SSRC team members are also part of the LCDA's Latino Club, the Society of Hispanic Professional Engineers, and First Robotics.

Costs:
- $25 team registration
- We ask parents to help bring meals to the team during our competition season meetings.

Scholarship opportunities are available to help offset costs.
Are you looking to be a member or a mentor?
Member's Name

First NameLast Name
Member's Birth Date

MonthDayYear
Member's Gender
Member's Race/Ethnicity
School
Grade
Member's E-mail
example@example.com
Mobile Number
Will be used to contact memberFormat: (000) 000-0000.
T-Shirt Size
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian
Emergency Contact(s)
Background, Experience, and Commitment

You are highly encouraged to attend every meeting! We meet Monday's and Friday's 4:30-6:30 PM
Do you have prior robotics experience?
If yes, which team(s) and/or camp(s)?
What conflicts do you expect for the Fall and Spring semester?
If none, put NONE
Can you commit to 2-4 hours a week?
Why are you interested in joining the Southside Robotics Club (SSRC)?
Juniors & Seniors: Please add your plans after you graduate
What are some likes and dislikes?
Ex: favorite movie, candy, hobby, etc.
Questions/Comments
Allergies, special accommodations, etc.
Authorization and Release

I, the parent/guardian, grant permission to the LCDA Latino Club and SHPE for the use of my child's image in various media formats, including but not limited to online, news, and print.
- I understand this consent is valid until revoked in writing by the parent/guardian.
- I release the Latino Community Development Agency (LCDA) and the Society of Hispanic Proessional Engineers (SHPE) from all liability and obligations from any claim for injury, illnesses, claims, or demands.
- I understand that I have the right to revoke this consent at any time by providing written notice to okcssrc@gmail.com.
- I understand that my child will not receive any monetary compensation.
- I/We hereby agree that we have read this agreement and are bound by it.
By clicking 'Submit,' you acknowledge that this action constitutes your electronic signature, affirming your consent and agreement to the terms and conditions provided as if you had signed a physical document.
Will you be needing a sponsoring scholarship?
Mentors do not need any robotic experience. We encourage parents and community members to be a part of the program as we rely heavily on volunteer involment. Members must be 18+ years old and be able to pass a background check.
Mentor Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Profession/Organization
Any robotics experience?
Race/Ethnicity
Please share your expertise and why you are interested in becoming a mentor

In addition to mentorship, are there any other ways you would like to be involved?

Other
Some companies support FIRST Robotics through team grants if someone involved with the team works for the company. Please indicate if you work for or know someone who works at one of these who might be able to fill out a short grant application or vouch for us. Or if you know of another company we should contact, please write it in "other"

Other
Additional Comments
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
School
Additional information

SSRC Email: okcssrc@gmail.com

Address: 420 SW 10th St. OKC, OK 73109
Should be Empty:

Rows	Monday	Friday	Both
4:30 PM-6:30 PM

SSRC Application Form

Background, Experience, and Commitment