2017-2018 STEM ACADEMY APPLICATION

STEM ACADEMY APPLICATION
Student Name

First Name Last Name
CCSD Student ID
Current School

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Student E-mail
Student Birthday
Student T-Shirt Size
Parent Name

First Name Last Name
Parent Phone Number

Area Code Phone Number
Parent E-mail
By clicking below, I acknowledge that I am giving the Walton STEM Academy permission to publish my address and contact information in the STEM Academy Directory if I am admitted into the program.

Yes, I agree.
By clicking below, I acknowledge that I am giving the Walton STEM Academy permission to photograph me and use my likeness in STEM Academy publications (website, newsletter, etc.) if I am admitted into the program.

Yes, I agree.
Teacher Recommendations

You will be asking your current English, Math and Science teachers to complete an online recommendation form. Please list the name and email address for each teacher below. All educator recommendations are confidential.
English Teacher Name

First Name Last Name
English Teacher Email
Math Teacher Name

First Name Last Name
Math Teacher Email
Science Teacher Name

First Name Last Name
Science Teacher Email
Pathway Interest

The Walton STEM Academy has three distinct majors: Advanced Math and Science, Biomedical Science and Engineering. Please indicate your preference for admission.
Advanced Math and Science Biomedical Science Engineering
Background Information
List and briefly explain any academic awards and/or honors that you have received since 6th grade in the order of the importance you place on them.
List any STEM-related extra-curricular activities you have participated in since 6th grade.
List any academic extra-curricular activities outside of STEM you have participated in since 6th grade.
List any non-academic extra-curricular activities you have participated in since 6th grade.
Essay Questions

The Walton STEM Academy is seeking highly motivated students who have a passion in the particular area of STEM for which they are applying. Please answer each question thoroughly.
Why are you interested in becoming part of the Walton STEM Academy?
What can you contribute to the Walton STEM Academy?
What do you expect to gain by completing the Walton STEM Academy and how will this program influence your future?
Explain something you have done or participated in that illustrates your passion about the area in which you want to major.
I declare these essays are my own work completed without assistance from others.

First Name Last Name
Should be Empty:

STEM ACADEMY APPLICATION

Teacher Recommendations

Pathway Interest

Background Information

Essay Questions