MESA Utah Parent Permission & Student Information Form (Granite School District)
2019-2020 Parent Permission
Dear Parent or Guardian:
Your child has been invited to participate in the Mathematics, Engineering, Science Achievement (MESA Utah) program. MESA is an educational program designed to encourage and prepare students for college majors and careers in mathematics, engineering, science and related fields. MESA Utah assists these students by offering the following and more:
• Science, technology, engineering and mathematics (STEM) based project activities
• College and career guidance
• Field trips and academic competitions
• Scholarships & Outstanding Student Awards
Currently, more than 80 schools and 4,200 students throughout the state of Utah are involved with MESA. As a member of MESA, your child will be involved in fun, hands-on activities to teach him/her principles of math, engineering and science. He/she will participate in special field trips to universities and companies, competitions, and guest speakers that will expose them to exciting and financially rewarding career possibilities.
I give permission for my child, (name listed below) to participate in the MESA Utah Program. I am in agreement with the goals of MESA. As a parent, I will encourage my child to strive to achieve these goals.
Additionally, I hereby grant the MESA/STEP Consortium of Utah and my school/district MESA program the right to obtain and/or use my child’s photograph, digitized image, video and/or voice recording for educational and informational purposes. I understand that such media and all subsequent uses of that media, including publications, presentations, web sites, videos and multimedia productions, become the property of the MESA/STEP Consortium of Utah and may be disseminated to the public via appropriate media channels.
I give permission for MESA/STEP Consortium of Utah to gather limited demographic and academic information about my child in the form below. This information will be used to create school MESA rosters. The information will also be used to track MESA participation throughout the state.
(Paper Version of Parent Permission Form:
I grant the permissions listed above.
N/A (I'm going to have my parent/guardian turn in the paper version of the Parent Permission form.)
Signature of Parent or Guardian: (By typing my name below, I am providing an electronic signature.)
2019-2020 Student Information Form
Student First Name
Student Last Name
Student ID Number
Granite School District
Granite: Bennion Junior High School
Granite: Bonneville Junior High School
Granite: Churchill Junior High School
Granite: Cottonwood High School
Granite: Cyprus High School
Granite: Eisenhower Junior High School
Granite: Evergreen Junior High School
Granite: Granger High School
Granite: Granite Connection High School
Granite: Granite Park Junior High School
Granite: Hunter High School
Granite: Hunter Junior High School
Granite: Jefferson, Thomas Junior High School
Granite: Kearns High School
Granite: Kearns Junior High School
Granite: Kennedy, John F. Junior High School
Granite: Matheson, Scott M. Junior High School
Granite: Olympus High School
Granite: Olympus Junior High School
Granite: Skyline High School
Granite: Taylorsville High School
Granite: Valley Junior High School
Granite: Wasatch Junior High School
Granite: West Lake STEM Junior High School
What school year did you first start participating in MESA?
What year were you born?
Race or Ethnicity (Mark all that apply)
American Indian /Alaska Native
African American / Black
Middle Eastern / Arab / Persian
Pacific Islander / Polynesian
Physics or Astronomy
Science or Math Teaching
This year I will be taking advanced classes in the following subjects (advanced classes include: Honors, GT, CE, AP, IB, etc.):
I am not taking advanced classes this year.
This year I may need tutoring in the following subjects: (Optional)
I probably won't need tutoring.
English Language Arts
Do you have any special dietary requirements? (Optional)
No special dietary needs
Email Address (Optional)
Cell Phone Number (Optional)
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