Lincoln County STEM Academy
July 9-13, 2018 9:30am - 2:30pm

All students enrolled in Lincoln County Schools during the 2017-18 school year are eligible to apply and participate if selected. Application is due no later than Friday, June 8, 2018 at 3:00 pm. BECAUSE OF THE POTENTIAL FOR INTEREST AND LIMITED NUMBER OF SPOTS- NO EXCEPTIONS WILL BE MADE TO THIS DEADLINE. Applications will be accepted via GOOGLE or you may turn in a hard copy at Lincoln County High School or Stanford Elementary- attention to Lydia Tiller or Diana Lane. If you turn in a hard copy of the application, please contact Lydia Tiller or Diana Lane prior to the deadline of June 8, 2018, and confirm receipt. PREFERRED METHOD FOR APPLICATION SUBMISSION IS ONLINE, BUT YOU MAY APPLY VIA HARD COPY IF NEEDED. Applications will be reviewed and Lincoln STEM Academy participants will be contacted by June 13, 2018.

Non-Discrimination Notice:

The Lincoln County Board of Education does not discriminate on the basis of race, color, national origin, sex, genetic information, disability, religion, marital status, or age in its programs and activities and provides equal access to its facilitates to the Boy Scouts and other designated youth groups.

The following have been designated to handle inquiries regarding nondiscrimination under Title IX and Section 504 of the Rehabilitation Act of 1973: Jackie Risden-Smith, Title IX Coordinator, or Claudia Godbey, Section 504 Coordinator, 305 Danville Ave., Stanford, KY 40484, (606) 365-2124.

Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Student Age *
Your answer
Student Gender *
School Student is Currently Attending *
Shirt Size *
Will your student need bus transportation? *
Student's Current Grade Level *
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Street Address (Student's Primary Residence) *
Your answer
City (Student's Primary Residence) *
Your answer
Zip Code (Student's Primary Residence) *
Your answer
Parent/Guardian Primary Phone Number *
Your answer
Emergency Contact #1 Full Name *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact #1 Driver's License Number *
Your answer
Emergency Contact #2 Full Name *
Your answer
Emergency Contact #2 Phone Number *
Your answer
Emergency Contact #2 Driver's License Number *
Your answer
Please List Any Allergies or Medical Conditions your student may have. *
Your answer
Please Select ONE Major STEM Focus (this is your first choice) *
Please Select ONE Minor STEM Focus (this is your second choice) *
2017-18 SCHOOL YEAR ATTENDANCE REQUIREMENT- Attendance is imperative. Students who have exceeded allowable absences (excused and unexcused) per district attendance policy (for the school year) must submit a statement or explanation below. This statement will be reviewed by the acceptance committee. Please write N/A if this is not applicable to your student. *
Your answer
Please list the STEM Experiences (science, engineering, technology, math) your child has had in the past. Please note- it is not mandatory that your child have past STEMexperiences- we are just interested to know if they have had any!
Your answer
Parent/Guardian Signature Acknowledgement- I have completed or am aware my student has completed this application and give permission for them to participate in the Lincoln STEM Academy July 9-13, 2018. Please sign (type) name, and the following phrase: I UNDERSTAND DAILY ATTENDANCE IS MANDATORY. *
Student Signature Acknowledgement- I have completed or am aware my parent/guardian has completed this application and commit to participate in the Lincoln STEM Academy July 9-13, 2018. Please sign (type) name, and the following phrase: I UNDERSTAND DAILY ATTENDANCE IS MANDATORY. *
Your answer
Please submit any questions or comments you may have for us. You may also contact us directly. Contact Information is below. We hope to answer any and all questions once students are selected for the academy!
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Contact Us:
REMINDER- This is a wonderful creative opportunity for the students of Lincoln County! It is completely FREE to attend! NO COST whatsoever- and NO FUNDRAISING! Each participant will get a free t-shirt and hours of valuable STEM instruction! Because of the high potential for interest from students, we ask that you apply in a timely manner. Applications are DUE no later than 3pm on June 8. ABSOLUTELY NO LATE APPLICATIONS WILL BE ACCEPTED.

If you have further questions or comments, please contact Lydia Tiller or Diana Lane at 859-379-8394 or 606-365-9111 or by email: lydia.tiller@lincoln.kyschools.us and/or diana.lane@lincoln.kyschools.us

A copy of your responses will be emailed to the address you provided.
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