Tech Savvy Student Application

July 24-28, 2017

I. GENERAL INFORMATION

First Name
Last Name
Age
Birth date (mm/dd/yyyy)
Student's E-Mail
Home Street Address
Apt.
City
State

Zip Code

Home Phone
Student's Mobile Phone

What grade are you currently in? 6th 7th

Is your family enrolled in SNAP, MA Health or TAFDC? YES NO
If you answered yes to above, please read information re: tuition

Name of Parent/Legal Guardian #1:
Daytime Phone:
Mobile Phone:
Email:

Name of Parent/Legal Guardian #2:
Daytime Phone:
Mobile Phone:
Email:

ACADEMIC INFORMATION

Name of School You are Attending:
Street Address:
City: State: Zip:

 

STUDENTS: PLEASE ANSWER THE FOLLOWING QUESTIONS IN YOUR OWN WORDS AND WITHOUT ASSISTANCE:

1.) How did you find out about the program?

2.) Why are you interested in attending the program ?

3.) What kind of activities do you enjoy doing?

4.) Have you participated in other science, technology, engineering, and/or mathematics enrichmentprograms before? If so, please list and describe your experience(s).

5.) What do you think you'll be doing in 10 years?

6.) What accomplishment of yours are you most proud of?