Fall 2017 STEM Prep Application - High School Students
Deadline: September 8, 2017 or until filled

This is a STEM (Science, Technology, Engineering and Mathematics) focused program designed to prepare current CPCC students and 11th and 12th graders who are interested in pursuing bachelor's degrees in a STEM discipline. Our funding agency, The National Science Foundation, provides support for this program for groups defined as historically under-represented in STEM disciplines (URM STEM students) that include: African-Americans, Alaskan Natives, American Indians, Hispanic Americans, Native Hawaiians, and Native Pacific Islanders.

The program will take place on Monday and Wednesday afternoons between the hours of 6pm - 8:15pm starting September 25, 2017 - November 15, 2017 along with a mandatory orientation meeting on September 21, 2017 at 6pm. Participants will be required to attend all sessions.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Date of Birth *
High School Name *
Current Grade Level *
What is your overall GPA as of the end of Spring Semester 2017? *
U. S. Citizen *
Gender *
Ethnicity *
Required
Home Address *
Street Number and Street Name
Apt #
City *
State *
Zip *
Primary Number *
Personal Email Address *
Parent/Guardian Name *
Parent/Guardian Email Address *
STEM area of Interest - First Choice *
STEM area of Interest - Second Choice *
What STEM courses have you taken and are you enrolled in for Fall 2017? *
List all Science, Technology, Engineering and Math courses.
What other things are you involved in at your high school or outside of school? *
Check all that apply
Required
What are your career goals/interest and why would you like to participate in this program? *
Do you have interest in obtaining a 4 year degree? *
This program will take place on CPCC's Central Campus so what mode of transportation will you be using to get here? *
Required
How did you hear about the STEM Prep Program? *
Required
Do you require any special accomodations? If so please explain. *
Please give your emergency contact name. *
Please give your emergency contact relationship *
Please give your emergency contact number *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of CPCC - Employees. Report Abuse
Google Forms