STEM Institute Online Registration Form

		STEM: Summer 2013 Registration Form	back to STEM
		Science,Technology,Engineering & Mathematics
		Select from courses on this Summer 2013 Registration Form. Please check the STEM website for any new announcements regarding 2012 Registration deadlines and Applications. Application must be postmarked by April 12, 2013. Deadline; final decision will be made by April 30th, 2013. Please download the required: >>Teacher Recommendation Form >> Download Official Transcript Request**

Last Name:

First Name:

Your HS OSI #:

Address:

Apt.#:

City:

State:

Postal/Zip Code:

Social Security #:

(enter format: xxx-dd-yyyy)

Student Cell Phone #:

E-Mail Address:

(Please print)

Date of Birth:

(enter format: xx-dd-yyyy)

Ethnicity:

Other:

(Please specify)

Citizenship::

Other:

(Please specify)

Student Gender:

Female

Male

Did you attend The STEM Institute before?:

Yes

If 'Yes' please enter when:

(Summer of xxyy)

Did you attend CollegeNOW before?:

Yes

If 'Yes' please enter when:

(Fall of xxyy and/or Spring of xxyy)

PARENT INFORMATION

Parent(s)/Guardian's Name:

Home/Cell Phone:

Work Phone:

EDUCATION

Current Grade:

Year Entered 9th Grade:

Graduation Date:

HS Average:

Math Average:

SAT Score Verbal:

SAT Score Math:

School Name:

Counselor Name:

School Address:

School City:

School State:

School Postal/Zip Code :

School Phone:

Phone Extension:

School E-Mail:

COURSES

Which GROUP are you applying for? Each group has two classes. Please check ONLY ONE. Applications with more than one group selected WILL NOT BE REVIEWED!

1. Calculus I (elective HS credit) 2. Engineering Design 10100 (non-credit). *Pre-requisite: Pre-calculus or a grade of 90 or better in Math B

1. Calculus I (elective HS credit) 2. College Critical Writing & Reading (1 elective HS credit). *Pre-requisite: Pre-calculus or a grade of 90 or better in Math B

1. College Pre-Calculus (1 elective HS credit) 2. General College Physics (1 elective HS credit). *Pre-requisite: A grade of 90 or better in Advanced Algebra or its equivalent

1. College Pre-Calculus (1 elective HS credit) 2. College Critical Writing & Reading (1 elective HS credit), Pre-requisite: Non-ESL students. *Pre-requisite: A grade of 90 or better in Advanced Algebra or its equivalent

1. Advanced College Algebra & Trigonometry (1 elective HS credit) *Pre-requisite: A grade of 90 or better in general Algebra. 2. MUST select ONE course:

Classes E.:

1. Engineering 103 (Computer Methods) (Non-credit) 2. *Select ONLY ONE Research area: *Pre-requites: Calculus I (with a grade of C+ or better) or AP Calculus AB (with a score of 4 or better).

Classes F.:

* Note: Group F is only available to students who meet the following two conditions: (1) Be a US Citizenship and (2) Be a Junior (11th) or Senior (12th). Students who conduct research will receive a small stipend.

REFERENCES

Math and Science teacher recommendations are required. Another person in your school, church or community is acceptable if your school does not have a math or science teacher.

MATH TEACHER:

Last Name:

First Name:

E_mail:

SCIENCE TEACHER:

Last name:

First Name:

E-mail:

Application and teacher recommendation forms must be postmarked by Friday, April 12th, 2013; final decision will be made by April 30th, 2013.

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