Materials Camp: Application

Application Deadline: Deadline has passed!

Student Information

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First Name:	Last Name:
Date of Birth:	Gender:	Male Female
Citizenship:	T-Shirt Size:	S M L XL 2XL

E-mail*:	Phone:
Address:	City:
State:	Zip Code:
*Most communication will be sent electronically.

Parent Information

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Father's Information
Father's Name:			Father's E-mail:
Father's Address:			City:
State:			Zip Code:
Day Phone:			Evening Phone:

Mother's Information
Mother's Name:			Mother's E-mail:
Mother's Address:			City:
State:			Zip Code:
Day Phone:			Evening Phone:

Education Information

______________________________________________

Will you graduate high school in the Spring of 2012 or 2013? Please note that only those students graduating in the Spring of 2012 or 2013 will be eligible.

Spring 2012 Spring 2013 Neither, I am not eligible

High School:

Principal's Name:

Address:

City:

State:

Zip Code:

Current School Year Grades in the following (if applicable):

Chemistry:

Physics:

Math:

Science:

Additional Information

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In the box provided, please explain in 200 words or less why you want to be selected for the MATERIALS CAMP. Please include your intended college major (if known) and any career interests you may have.

Last updated June 30, 2011