STUDENT APPLICATION FORM – SUMMER 2015 Rising Eighth Graders STEM Camp at the University of Texas—Pan American August 2nd – 7th Camp Information: This weeklong residential camp promoting science, technology, engineering and mathematics is organized to provide activities, experiments and projects for rising 8th‐grade STISD students. The camp will focus on increasing students’ STEM skills while introducing them to college life and promoting Science, Technology, Engineering and Mathematics (STEM) subjects as a potential career path. Campers will attend classes that include problem solving, research and communication skills incorporated with STEM subjects including physics, engineering and Earth sciences. The camp will be held at the University of Texas—Pan American, located at 1201 W. University Drive in Edinburg, Texas. Students will be housed in a dorm on the university’s campus under strict supervision. Who Should Apply?
Rising 8th grade students at STPA
Students interested in a future STEM career or students interested in learning more about STEM related fields
Parent/Guardian and student complete the attached student application form.
Student writes a one page (250 word max) essay.
Student gives current Science and Math teacher a recommendation form to be completed.
APPLICATION DEADLINE IS Wednesday 1, 2015 NO EXCEPTIONS.
UTPA STEM Camp Student Application Form Summer 2015
APPLICATION DEADLINE IS April 1, 2015 Please type or print clearly in dark blue or black ink. Name of Current 7th Grade Student: ________________________________________________ Home Address: _________________________________________________________________
________________________________________________________________________ City State Zip Code
Student Email Address: __________________________________________________________ Student Cell Phone (if applicable): __________________________________________________ Please list school organizations, any science and/or mathematics activities (Science Fair, math club, after school programs, summer programs, etc.) you have participated in. Include awards received and offices held. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Please list any community activities and/or community groups that you have been a part of. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Please list any other activity or achievement that you would like to share with the selection committee. _____________________________________________________________________________________ _____________________________________________________________________________________ How confident are you in your ability to set goals? (Circle response) Not at all Confident
How confident are you about what you want to be when you grow up? (Circle response) Not at all Confident
How often do you reach the goals you set? (Circle response) Never
How often do you think about high school, college, and beyond (Circle response) Never
How committed are you to your school work? (Circle response) Not committed
A student‐written essay must be included with this application. The student essay is to be typed using Arial, Helvetica, or Times New Roman and a 12 point font. The essay is not to exceed 250 words (one double‐spaced page). In your essay, tell the selection committee why you are interested in attending the STEM camp at The University of Texas—Pan American. Include in your essay what you hope to gain from this experience and how you think it will help you in the future. Be sure to write your name at the top of your essay. _______________________________________________ _________________________ Signature of Student Date
Parent/Guardian Information Instructions: Please complete the following information for at least one custodial parent, guardian, both, if available. Name of Parent or Guardian: ______________________________________________________ Relationship: _________________________ Daytime Phone No.: ________________________ Cell Phone No.: _______________________ Home Phone No.: __________________________ Email Address: _________________________________________________________________ _______________________________________________ _________________________ Signature of Parent or Guardian Date Name of Parent or Guardian: ______________________________________________________ Relationship: _________________________ Daytime Phone No.: ________________________ Cell Phone No.: _______________________ Home Phone No.: __________________________ Email Address: _________________________________________________________________ _______________________________________________ _________________________ Signature of Parent or Guardian Date
APPLICANT REFERENCE FORM Student’s Last Name: ________________________________ First:______________________________ Name of Math or Science Teacher: ________________________________________________________ TO THE EVALUATOR: Please fill out the information included in this form. When you have completed the form, please place it in a sealed envelope with the student’s name printed on the front of the envelope (the student must provide the envelope to the teacher). This form must be submitted to the STPA Administration Office by April 1, 2015. Thank you very much. Please rate the student in all categories relative to other 7th graders. Place a ( ) in the field that best describes the student’s characteristic. Please include comments that provide any information you feel would be helpful in assessing the student's qualifications: Characteristics
Outstanding Excellent Good Average
Commitment to schoolwork
Ability to adapt to new situations
Analytical problem solving
Scientific / Math knowledge
Other Comments: _________________________________________________________________________________ _________________________________________________________________________________
_____________________________________________ _________________________ Signature of Evaluator Date Application Deadline: April 1, 2015 4:00pm
Media Permission Form University of Texas‐Pan American STEM Camp Student Name: (Please Print) _________________________________________________________ Session Attended August 2nd – 7th _____ I hereby grant permission to use my child’s name, picture and comments in materials (television, video, world‐wide web, audio and printed media) used to promote the STPA Rising 8th ‐Graders Camp. _____ I do not give such permission. _______________________________________ ______________________ Parent/Guardian Signature Date If you have questions regarding this form, please contact STISD Public Relations & Marketing Coordinator Amanda Odom at (956) 514‐4255.