Future Tech Master's Application Form

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Welcome to the application for the Future Tech Master's robotics program.

Which program are you interested in?

FUTURE TECH MASTERS ROBOTICS

21st CENTURY STEM NSBE JR CHAPTER (Grades 8th-12th)

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Student's First Name *

Student's Last Name *

Gender *

Age *

T-Shirt Sizes (student) *

School Attending for 2015-2016 *

Grade Level (2015-2016 school year): *

Please list any allergies and/or dietary restrictions: *

Please list any medical conditions that we should be aware of: *

Student Questionnaire

Do you have experience with robotics? *

Ex: Involved with the FIRST Lego League, past robotics camps or workshops, own Lego NXT, Sea Perch

If yes, please explain:

How did you hear about us?

Parent/Guardian Contact Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Address (street, city, state, zip code) *

Primary Email Address: *

This will be the email address we will use to contact you.

Primary Phone Number *

This is the primary number we will use to contact you.

Phone Number (alternate)

This is the secondary number we will use in case will cannot reach you at your primary contact.

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