2019-20 Elementary STEM Club Application
OSU Extension, Pickaway County and Teays Valley School District have teamed up to plan and implement the district’s third annual after-school elementary-wide STEM Club. We will meet approximately 2 times per month in each of the four elementary buildings from 3:30-5:00 pm.  Participants will be limited to 30 students per building. Acceptance in the after-school program will be an application based lottery. There will be a $ 25 fee for the year with financial hardship waivers available. The fee can be cash or check (written out to OSU Extension, Pickaway County) and turned in at the first STEM Club meeting or mailed to OSU Extension, Pickaway County, P.O. Box 9, Circleville, OH 43113. We will be having a STEM Club blog at  http://u.osu.edu/tvstemclub/. This website will have club highlights, activity summaries, and access to the STEM Club calendar for your student’s STEM Club meetings.

The goal of the program is to promote student interest and engagement in STEM in each of the elementaries. This program is considered an extension of the school day. Participants will be engaged in hands-on STEM activities and learn about careers in STEM.

Students who may enjoy STEM club are those who enjoy being challenged and who are interested in:
- the fields of STEM (science, technology, engineering, math)
- the process of learning, asking questions and problem solving
- helping people and making a difference in the world

If your child is interested in participating in the lottery visit the STEM Club Blog site for information and complete the application below.  Applications must be submitted online by the end of the school day, Friday, August 23rd. NO LATE APPLICATIONS BECAUSE IT IS A LOTTERY! (STEM Club Meeting dates are subject to change. In the event of school cancellation, STEM club will be canceled and not rescheduled.)

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2019-2020 STEM Club Dates:
Instructions
A $25 fee for the year can be turned in at the first STEM Club meeting or mailed to OSU Extension, Pickaway County, P.O. Box 9, Circleville, OH 43113. (Please make checks out to OSU Extension, Pickaway County). Please answer the questions below. Application is due end of the school day, Friday, August 23rd. NO APPLICATIONS WILL BE ACCEPTED THEREAFTER, BECAUSE IT’S A LOTTERY! Students will be notified of acceptance or non-acceptance into the program shortly thereafter via email.
Parent Portion
Make sure everything is current in case of emergency.
Student Name *
School Building Name *
Grade *
Homeroom Teacher's Name *
Parent/Guardian Name *
Parent/Guardian Primary Number *
Parent/Guardian Email *
Ethnicity of student (for 4-H federal reporting purposes only) *
Residence of student (for 4-H federal reporting purposes only) *
* Notification of acceptance/non-acceptance will be sent by email. This is how we primarily communicate with parents throughout the year as well as posting to STEM Club Blog, u.osu.edu/tvstemclub/
Please put a check box if a financial hardship waiver is needed. This will be kept confidential.
Student Portion
Please talk to your parent(s) or guardian(s) and learn about their work experience and different career paths.
If it’s ok, please add your parents career(s) below. We’re interested in learning more about local professional to draw from for career exploration events and future STEM programs.  
We expect the participants to be respectful and engaged during each STEM Club Meeting. Were you ever sent to the office or lose your recess because of poor behavior last year school year?   *
Expectations
Students participating in STEM Club will stay after-school at their respective building.  Students must be picked-up after each session by 5:00.  (Pick-up time is very important in this program.  If your child is not picked up by 5:00 after two sessions, they may be removed from the program.)

Participation in STEM Club is a privilege.  Proper school behavior is expected.  Students who do follow expectations may be removed from the program.

By signing below, I am acknowledging that I understand the rules and guidelines for participation in STEM Club.  

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By signing below, I am acknowledging that I understand the rules and guidelines for participation in STEM Club.
Parent/Guardian's Signature (sign by typing full name)
Student's Signature (sign by typing full name)
The sustainability of the club lies between the continued partnership of OSU Extension, Teays Valley School District, grants, business sponsorships, creative collaboration between professionals and academics, as well as, charging a nominal participation fee with financial hardship waivers available. We want our club to continue to be a safe and inspiring meet-up to learn and explore STEM in all its forms and interdisciplinary problems and solutions.
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