Innovations in STEM (i-STEM) 2024

Camp Registration Form

Student First Name *

Student Middle Initial *

Student Last Name *

Student Preferred Name (Name to be printed on camper name badge; e.g. Steven to Steve) *

Mailing Address *

Country

Street

City

Region

Postal Code

Student Email Address *

Confirm Student Email Address *

Student Phone Number (xxx-xxx-xxxx) * (cell number while at camp)

Demographic Information

Gender *

Female

Male

Other

If other, please specify

Date of Birth *

Age of Student During Camp * (numeric values; e.g. 15)

School Currently Attending *

Grade Level This Fall *

Year Student will Graduate from High School; e.g. 2030 *

Ethnicity

Is student of Hispanic or Latino origin?

Yes

No

Miscellaneous Camper Information

T-Shirt Size (adult sizes) *

First and Last Name of Requested Roommate (not guaranteed)

Are you interested in receiving information about need-based scholarships for summer camps?

Yes

No

How did you first hear about S&T's summer camps? *

If other, please indicate how you heard about the camp. *

Why did you select a S&T camp for your K-12 student? Please select all that apply. *

If other, please specify

Has your student attended an event on the S&T campus in the past? *

Yes

No

If yes, what level(s) of school was your student when they visited? Please select all that apply. *

Elementary School

Middle School

High School

Has your student attended a S&T summer camp in the past? *

Yes

No

If yes, what level(s) of school was your student when they attended a camp? Please select all that apply. *

Elementary School

Middle School

High School

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Daytime Phone (xxx-xxx-xxxx) *

Evening Phone (xxx-xxx-xxxx)

Parent/Guardian Email Address *

Confirm Parent/Guardian Email *

Have either of the student's parents/guardians completed a bachelor’s degree? *

Pickup/Transportation Information

End of Camp Transportation Information *

Please provide the names (first/last) of all authorized persons allowed to pick your student up from camp:

Please provide the name (first/last) of the authorized person your student will ride home with from camp:

STEM Center

Innovations in STEM (i-STEM) 2024

Missouri University of Science and Technology

#MINERSDIGDEEPER