2019-20 Nextech Catapult Application
Please complete and submit the application by February 26, 2019.
Program Eligibility Requirements
To be eligible for this program, you must meet all of the following criteria. Please check off all of the boxes that currently apply to you.
*
Required
Tell Us About Yourself
Full Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Street Address *
Your answer
City, State and ZIP Code *
Your answer
Contact Email *
Your answer
Contact Phone Number *
Your answer
Tell Us About Your Education and Experiences
School You Are Currently Enrolled In *
Current Grade *
Which of the following areas have you studied? *
I have not studied
I studied on my own
I studied as part of a class
Computer Science Principles
AP Computer Science
Web Design (HTML, CSS, etc.)
Web Development (JavaScript, Python...)
Informatics
Mobile App Development
Cybersecurity
Computer Repair
Computer Networking
Graphic Design Tools (Photoshop, Illustrator, InDesign etc.)
Multimedia Design Software
GPA in Computer Science Courses *
Your answer
Cumulative GPA (your cumulative GPA for all classes you've taken in high school) *
Your answer
What is your skill level with the following? *
I've Never Used
I'm Still Learning
I'm Pretty Good
I'm an Expert
HTML
CSS
JavaScript
Design Thinking
Marvel
React
Adobe
JQuery
Slack
Git
Have you built and published a website? *
What is the URL of the website?
Your answer
What is your comfort level in the following situations? *
Not Comfortable
Somewhat Comfortable
Comfortable
Very Comfortable
Meeting new people
Engaging with business leaders
Presenting to a group of 10 or more people
Working independently
Working in groups
Being the leader as part of a bigger team
Engaging with people of authority
Personal Attitudes and Goals
What is your response to the following statements? *
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I have role models in computer science/coding/technology that are the same GENDER as me.
I have role models in computer science/coding/technology that are the same ETHNICITY as me.
I know a lot of students like me who are interested in computer science/coding/technology.
I feel like I am part of a community of students who are interested in computer science/coding/technology.
I have a group of peers that will support me in reaching my computer science/coding/technology goals.
List and explain your 3 greatest strengths. *
Your answer
What is a personal achievement that makes you feel proud? *
Your answer
How would you define coding and why should young people learn it? *
Your answer
Tell us more about the individuals you know in the tech field and the nature of your relationship. *
Your answer
Tell us about any goals or plans you have to pursue a career in technology once you graduate from high school. *
Your answer
Catapult Program
Based on what you know about the Catapult program, how would you describe it? *
Your answer
Why are you applying to Catapult? *
Your answer
How will being a part of the Catapult program help you? *
Your answer
Why should Nextech select you for participation in the Catapult program? *
Your answer
Who referred you to the Catapult program? *
Your answer
Tell Us About Your Schedule and Availability
Your responses to the following questions will not impact your chances to be selected to the program. We are simply collecting the information we need to coordinate the Catapult schedule and various logistics to accommodate program participants.
Are you currently participating in any programs at the following locations? *
Required
Are you currently participating in any of the following programs? *
Required
Do you participate in any of the following extracurricular activities? *
Required
Please tell us more about any extra-curricular activities you are involved in. *
Your answer
Which of the following timeframes do you think you will be available? *
Required
Do you have access to reliable transportation during the Summer and on weekends during the school year? *
The Catapult program has many important events/workshops during the school year. Are you available during the school year to attend these events? *
References
Please provide the name and email address for two references. The individual cannot be a relative, guardian or classmate and must be at least 18 years old. Nextech will follow up with each of these individuals to secure the actual reference. It is important that you contact the references and let them know they will be receiving an email from the Nextech staff requesting the completion of a reference form. To be considered for the Catapult program, you MUST have 2 references on file.
Full Name of Reference #1 *
Your answer
Email Address of Reference #1 *
Your answer
Please identify the role this individual plays in your life. *
Full Name of Reference #2 *
Your answer
Email Address of Reference #2 *
Your answer
Please identify the role this individual plays in your life. *
Submission
Your signature below certifies that all of your submissions on this form are true. Please type your name on signature line.
Signature *
Your answer
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