Amphibious Achievement: New Achiever Application
Thank you for considering applying to Amphibious Achievement at MIT. Please fill out this application if you would like to participate in the program in Spring 2017. Once you have completed this application and legal forms (will be emailed after you fill out the app), you will be considered to become an Achiever! Please contact amphibious-coordinators@mit.edu with any questions.
What semester are you applying for? *
First Name *
Your answer
Last Name *
Your answer
NOTE: The following questions are to collect background information and will not affect your application. Please answer all to the best of your ability!
Email Address *
Your answer
Confirm Email Address *
Your answer
Cell Phone Number *
If you do not have a cell phone number, please put N/A in the box below.
Your answer
Home Phone Number *
If you do not have a home phone number, please put N/A in the box below.
Your answer
Home Street Address *
Example: 111 Red Street #12E
Your answer
City/Town, States *
Example: Boston, MA
Your answer
Zip Code *
Example: 02115
Your answer
Gender *
Year of Birth *
Example: 1998
Your answer
Day of Birth *
Month of Birth *
Year in Highschool (Graduation Year) *
What is your race? *
Please choose the option that mostly closely describes your race. Your response will not affect any admissions decisions whatsoever.
Are you Bi-racial or Multi-racial? *
Please choose the option that mostly closely describes your race. Your response will not affect any admissions decisions whatsoever.
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian Cell Phone Number *
Example: (000) 000-0000
Your answer
Parent/Guardian Email Address *
Your answer
Do you live in a single-parent household? *
Did at least one of your parents attend college? *
Which language is your parent or guardian most comfortable speaking?
Is English your first language? *
What languages can you speak fluently? *
Required
Do you have any siblings in Amphibious Achievement?
What is the most common mode you use to get to MIT for Amphibious Achievement sessions?
How did you hear about Amphibious Achievement? *
Required
If you were referred by a teacher, please list his/her name below. *
If you were not referred, please type "N/A"
Your answer
What high school do you attend? *
Please pick the statement below that best describes your grades across all subjects. *
This will not affect your acceptance to the program whatsoever.
What is your current Grade Point Average (GPA) on a 4.0 scale? *
Please answer to the best of your ability. This will not affect your acceptance to the program whatsoever.
Your answer
Have you ever repeated a grade? *
Do you qualify for free or reduced priced school lunches based on family income? *
Do you have any adult family members OR adult friends who you are close to and look up to? If so, how many adults? *
Do you have any dietary restrictions or food allergies? *
We provide free breakfast and lunch in Amphibious Achievement! If you do not have any restrictions or allergies, please put N/A.
Your answer
Note: The following questions will be used to pair you with your mentor if you are accepted into the program. These responses will also help us to tailor the program so that it is most effective for you. Your responses will have NO affect on your acceptance. Please answer as honestly as possible!
What careers would you like to explore more to help understand your own career interests? (e.g. Veterinarian, Engineer, Journalist...) *
Your answer
What do you like to do in your free time? (e.g. Play basketball, paint, hang out with friends) *
Your answer
Please tell us whether you agree or disagree to the following questions as well. *
Your responses will no affect your acceptance whatsoever.
1 (Disagree a lot)
2 (Disagree)
3 (Agree)
4 (Agree a lot)
On the whole, I am satisfied with myself.
I wish I could have more respect for myself.
I take a positive attitude toward myself.
Please honestly answer the following *
Your responses will not affect your acceptance to the program whatsoever.
1 (Not at all important)
2
3
4
5 (Very important)
How important is a high school education for your future job?
How important is a high school education is for your future life?
How important is a college education is for your future job?
How important is a college education is for your future life?
How important is participation in athletics for your future job?
How important is participation in athletics for your future life?
Note: The following questions will be considered to determine your role if you are accepted to Amphibious Achievement this semester!
If accepted to Amphibious Achievement, which sport do you want to participate in? *
If you indicated interest in swimming, please choose a swim suit size. *
During the academic session in Amphibious Achievement on Sundays, we work in small groups. Are there any other Achievers that you would like to work with? Note that we are not guaranteeing that you will work with who you specify. If not, please put N/A. *
Again, this is no guarantee that you will work with these Achievers, but we will take into consideration.
Your answer
Do you have a preference for which mentor you would like to work with? If so, please put their name, if not, please put N/A. *
Your answer
Amphibious Achievement requires students to be actively involved in the program. Therefore attendance is critical. If accepted to Amphibious Achievement, please express your commitment to attending all sessions (Sundays from 8:30am-1pm, February 26st-May 7th). *
If you are a junior or senior in high school and have an interest in applying to college, we would like to help you prepare for college. Do you want to sign up for weekly college sessions from 1pm-2pm every week after Amphibious Achievement’s normal Sunday sessions? During these sessions we will help with college essays, the common application, the FAFSA, college application waiver fees, and scholarships. We’ll work with you to make sure you get into college and succeed. *
Thank you for applying to Amphibious Achievement!
Applications and legal forms are due by 11:59pm on January 31st for all returning applicants! Please continue to check your email after submitting the application because both you and your legal guardian need to sign legal forms we will be sending you!

The first day of Amphibious Achievement will be February 26th!

For more information, please contact us at amphibious-coordinators@mit.edu.

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