Young Women In Science STEM Summer Mentor Training 2019

STEM Summer Mentor Training is for female identified students entering grades 8 through 12 who are committing to mentor throughout the school year at the Girls Science Cubs, STEAM Teams, or Robotics programs.

Dates: August 5th-9th
Time: 9am-3:30pm
Cost: Free for all mentors

Please note: This form may only be used to register one child at a time.

Applicant Info
Child First Name *
Your answer
Child Last Name *
Your answer
Date of Birth *
Please use format month/day/year
Your answer
School *
Select a School
Grade *
Grade completed as of end of previous school year.
Science Teacher *
Your answer
Has your child participated in a Flying Cloud Insititute program before? *
If yes, in which program(s)?
If no, how did you hear about this program? *
Parent/Guardian Info
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Email Address *
Enrollment confirmation and payment information will be sent to this address.
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone *
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Medical Information
Please answer all questions below.
Does your child have asthma? *
If yes, does your child use an inhaler?
Does your child have any allergies? *
If yes, what allergies?
Your answer
If yes, does your child carry an EpiPen?
Does your child take any medication the Flying Cloud Institute staff should be aware of? *
If yes, what medication(s)?
Your answer
Does your child have any learning or social challenges the Flying Cloud Institute staff should be aware of? *
If yes, please use this space for a description of the challenge(s) and best ways to address if necessary.
Your answer
Permissions
Permission to Participate *
I give permission for photos, video or artwork of or by my child to be used for promotional material by FCI. *
Payment
Program Cost:
This program is FREE for all participants
Are you interested in sponsoring a scholarship for a Young Women In Science student? *
Please indicate below if you are interested in giving a full or partial scholarship for one of our other STEM Summer programs. By indicating yes, you will receive more information about our sponsorship program
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