Girls Engaged in Math and Science Registration

If you would like to participate in the upcoming GEMS workshop to be held June 18 - June 22 daily, from 9 a.m. - 3 p.m., please fill out the following application form no later than April 30, 2012. Applications will be reviewed by a committee based on the information given. Notification of acceptance into the program will be sent by email no later than May 15, 2012. Girls MUST have COMPLETED 6th or 7th grade by June 2012. All of the information requested below is required for consideration into the program. The policy statement must be signed upon acceptance into the program.

1. First Name:

2. Last Name:

3. Name for name badge (ex. Jane Doe)

4. Address:

5. City:

6. Zip code: answer must be a zipcode like 61864 or 61864-8180

7. Home Phone (format: xxx-xxx-xxxx) answer must be phone number with area code like 217-333-1000

8. Parent/Guardian Daytime Phone (format: xxx-xxx-xxxx) answer must be phone number with area code like 217-333-1000

9. School

10. Science Teacher:

11. Math Teacher:

12. Current grade level:

13. Age: answer must be numeric

14. Parent / Guardian email: answer must be an email address

15. Student's email: answer must be an email address

Please complete this statement using 500 words or less. Your essay will be important in determining whether you will be admitted into the GEMS program, so please make sure your answer accurately represents your feelings.

16. I want to attend the GEMS workshop because:

limited to 500 words.

17. Shirt Size:

Enter text for question 17 other

Girls Engaged in Math and Science Registration