HIMB Marine Science Club Application 2018-2019
Please know that this application will probably take at least 10 minutes to complete (unless you are Berry Allen), and there is a 300 word essay included in this application. Please read through the all the questions before starting. You may also write your essay in MS Word so that you can save along the way; then copy/paste here when ready.
Student First Name *
Your answer
Student Last Name *
Your answer
Student ID# *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Email Address *
Your answer
Phone Number *
Please include hyphens (eg: 808-123-4567)
Your answer
Cellular Carrier
AT&T, Verizon, Sprint, T-Moble, etc...
Your answer
Home Address *
Your answer
City / Town *
Your answer
Emergency Contact Name *
The first and last name of who we should contact in case of emergency
Your answer
Relation of Emergency Contact *
Ex: My emergency contact is my ________ (Mother, Father, friend, etc.)
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Email *
Your answer
School Attending for 2018-2019 Academic Year *
Your answer
Grade Level for 2018-2019 Academic Year *
What is your heritage/ancestry?
Your answer
Why do you want to join the Kulia Marine Science Club?
Please tell us who you are, what you're interested in, and what you hope to gain from KMSC?
Your answer
Method of transportation
How will you be arriving? Select all that apply
Arrival Location
Where will you arrive at the beginning of each program?
Departure Location
From where will you be picked up or leave from?
Will you be able to attend all or most meetings?
Will you have any other responsibilities that may overlap with the 2:30-5:00pm schedule
Extracurricular activities, work, etc...
Your answer
How would you rate your swimming ability?
Snorkel experience?
Never been
Able to free dive to 20+ feet
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