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* indicates a required field

First Name *


Middle Name


Last Name *


Suffix


Are you a citizen of the United States? *

Social Security Number *


No dashes

Birth Date *


DD-MM-YEAR, for example, 01-FEB-1998

Gender *

Race *

Check all that apply

What size t-shirt do you wear? *


Current Mailing Address *


City (Required for all except APO/FPO)


State (Required for US)


APO/FPO (Required for military post offices only)


Country (Required for international addresses only)


Zip Code (Required for all US addresses)


Email Address *


Phone Number (Please include Area Code) *


How did you hear about the West Point STEM Program? *


First Name of Parent or Guardian *


Last Name of Parent or Guardian *


Relationship of Guardian to Student *


Parent or Guardian Phone Number (Please include Area Code) *


Parent or Guardian Email Address *


Name of Current School *


Address of Current School *


Are you homeschooled? *

What grade will you be entering the next academic year? *


(Usually Fall 2013)

Expected Year of High School Graduation: (YYYY) *


Current Grade Point Average *


Honor Courses:

Note if any of the following are Honors Courses (Select all that apply).

Activities:

Please note activities that you have participated in during the last year.  Select all that apply

Leadership Role: *

Have you ever held a leadership position in a non-athletic extra curricular activity? (Officer, club president, drum major, etc.)

Remarks


Additional comments regarding academic achievements or activities:

Teacher 1 Name *


Teacher reference name.

Teacher 1 Phone Number *


Teacher reference phone number

Teacher 1 Email Address *


Teacher reference Email Address

Teacher 2 Name *


Teacher 2 Phone Number *


Teacher 2 Email Address *


Personal Statement *

In a well developed essay, tell us why you are interested in STEM.  Include information about why you would like to attend the workshop and what your goals are for your future. (Please limit your answer to 1,000 characters)

Acceptance *

1. I certify that my parent or guardian is aware and approves that I am submitting this application and approves of my participation in the STEM Workshop.
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