STEM SUMMER PROGRAM APPLICATION

STEM SUMMER PROGRAM APPLICATION

MEDGAR AND ANGELA SCOTT FOUNDATION
Student's Name*
DOB (mm/dd/yyyy)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best Day Time Phone (include area code)*
E-Mail*
example@example.com
2021-22 School Attended and Grade*
Cumulative GPA*
Parent(s) or Guardian(s) Name*
Please attach a copy of the student's Fall 2021 semester final report card below.*

The student's report card IS attached.The student's report card IS NOT attached.
File Upload

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List math and science classes completed and final letter grade achieved for each.*
Program Requirements:

Students must exhibit the following characteristics during this 8 week program.
- Good Work
- Self-Motivation
- Organizational Skills
- Positive Attitude
- Collaboration and Cooperation with Others
By completing and signing this application, I acknowledge and agree to the program requirements. I acknowledge that pictures of students and program activities will be included on our website and various printed materials for promotional purposes.
Student Signature*

Clear
Date*

MonthDayYear
Date
Parent or Guardian Signature*

Clear
Date*

MonthDayYear
Date
Selected candidates will be notified by May 25, 2022.
Should be Empty: