PSI Program - Application 2023
Please complete this form by Friday December 16th at 11:59 PM in addition to the teacher recommendation. You will receive a confirmation email on December 17th that you have submitted your application.

NO LATE APPLICATIONS WILL BE ACCEPTED. A completed submission consists of the application AND the teacher recommendation.
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Email *
Your First Name *
Your Last Name *
School Email Address *
Personal Email Address *
What are your preferred pronouns?
Clear selection
When is your birthday? mm/dd/yyyy *
Will you be 16 or older by June 1, 2022? *You can still be in the program if the answer is "no". *
Are you eligible for free and reduced lunch? *
What best describes your race or ethnicity? Select all that apply. *
Street Address *
City *
State *
Zip Code *
List an Emergency Contact Name, Phone Number, Email (Ideally a parent or guardian) *
What is the highest level of education one of your parents/guardians have completed? *
What is the highest level of education the other of your parents/guardians have completed? *
Name of Your Current High School *
Name of Your School District (If your school is an online academy please state that). *
What is your student ID number? (For communications with your registrar). *
What grade are you in now? *
Have you previously applied to the PSI Program? *
If you are accepted are you interested in participating in the optional summer research internship? (*Your answer to this question does not impact your chances of being accepted.) *
How did you hear about the PSI Program? Please check all that apply. *
For the next 3 questions, please list 1-3 courses in the STEM field you have recently taken that you believe are relevant to the PSI program. Please avoid acronyms.  

Course #1:
Course #2:
Course #3:
Please explain what you hope to gain from the PSI program and why you are interested in the program? Answer should be between 250-500 words. *
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