STEM Center - Information Request Form

If you would like to receive more information about the Kummer Center for STEM Education program offerings or Summer Camp programming, please fill out the information below. If you have immediate questions, please contact us at stemcenter@mst.edu or 573-341-6204

I am a*

Parent/Guardian

Student

Educator

Family/Friend of a School-Aged Child

First Name*

Last Name*

Email Address*

Are you 13 years of age or older?*

Yes

No

Student Email Address

Parent/Guardian's Email Address*

Mailing Address

Country

Street

City

Region

Postal Code

Student's Gender*

Female

Male

Non-Binary

No Response

School District Student Currently Attends*

Student's Current Grade Level*

Are you of Hispanic or Latino origin?*

Yes

No

Career path interest of student?

What other STEM programs would you like to see offered?*

What Day Summer Camp experiences are you interested in? (select as many as you want)

K-2nd STEM Camp

3rd-5th STEM Camp

STEM Center - Information Request Form

Missouri University of Science and Technology

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