BWIC PATHWAYS TO STEM WORKSHOP APPLICATION
The BWiC (Black Women in Computing) Pathways to STEM Workshops are one-day development workshops hosted to promote creativity, problem-solving and exploration of computing sciences. Participants will develop their own fully-functional, interactive video games, apps and artwork. The purpose of this workshop is to increase students’ interest in computer science and programming, to promote education and careers in science, technology, engineering and mathematics (STEM), and to support historically under-served and underrepresented students with limited opportunities or access to resources in these areas. This workshop is geared toward students and families with no prior experience in computer science or programming. The BWiC Gaming Workshop is being offered free of charge to participants.

The Parent/Guardian and student must complete and submit the student application form. If selected to participate, students must be accompanied to the workshop by the Parent/Guardian indicated on the application (parents please bring state issued identification). Parental authorization is required (via signature) at registration prior to student participation. The student will not be allowed to participate without it.

By completing this application, you agree to the rules, regulations and disclaimer included in the workshop program information.

SELECT WORKSHOP LOCATION & DATE: *
Student Information
Student First Name *
Your answer
Student Last Name *
Your answer
Student's Email address
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Ethnicity *
Required
Parent/Guardian Information
Occupation (optional)
Your answer
Parent/Guardian Full Name *
If selected to participate, students must be accompanied to the workshop by the Parent/Guardian indicated on the application (parents please bring state issued identification).
Your answer
Phone *
Preferably a cell number
Your answer
Parents' Email address *
Your answer
Will a family member be attending the Pathways to STEM panel? *
Attendance is not required and in no way affects the student's chances of being selected to participate in the workshop.
Please indicate the highest educational level attained by your father (optional)
Please indicate the highest educational level attained by your mother (optional)
Home Address
Street Address *
Your answer
City/Town *
Your answer
Zip *
Your answer
Phone *
(ex. 5552310987)
Your answer
Short Answers
Name of School student is currently attending (optional)
Please put N/A if student is home schooled
Your answer
Type of school (optional)
Is the student eligible for free/reduced lunch?
Does your school offer any technical programs (i.e. Computer Science class or club, Robotics club, etc.) If yes, please list them and indicate any in which you participate (optional)
Your answer
Do you have any previous programming experience? If yes, please describe (optional)
Your answer
Does your household have a computer?
Please list school organizations, any science and/or mathematics activities (Science Fair, math club, after school programs, summer programs, etc.) you have participated in and the years you participated. Include awards received and offices held if applicable (optional)
Your answer
Please list any other activity or achievement that you would like to share with the selection committee (optional)
Your answer
Briefly (no more than 3 sentences) please tell the selection committee why you are interested in attending the BWiC Pathways to STEM Workshop. Include in your response what you hope to gain from this experience, how you think it will help you in the future.
Your answer
Please tell us how you found out about the Pathways to STEM Workshop *
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