High School Academy 2013 Application
Please review the application process on http://tli.cs.pitt.edu  before beginning to apply.  The deadline is June 8th!
Sign in to Google to save your progress. Learn more
Student Information
First name *
Last name *
Suffix
Address 1 *
Street address
Address 2
City *
State *
Zip *
Email *
Home phone *
Mobile phone
Date of birth *
mm/dd/yyyy
Sex *
Ethnicity
Which (if any) TLI programs have you attended in the past?
Academic Information
School District *
School *
Grade you will be going into *
GPA *
Max GPA possible *
What statement below best describes how you first learned about TLI? *
When you graduate high school do you plan to go to a 4-year college/university? technical school? community college? What area(s) are you interested in studying? What are your career plans and interests? *
Do you currently have or plan to have summer employment? If so, does expected work schedule conflict with any program dates or times? Do you have any vacations or planned trips that conflict with your participation?  
List any other other information you may think relevant
Family Information
Applicant lives with
Check all that apply
Number of brothers
Number of sisters
Primary Parent/Guardian
Complete for at least one parent/gaurdian
First name *
Last name *
Sex *
Address 1 *
Street address
Address 2
City *
State *
Zip *
Email
Home phone *
Alternative phone
Marital status
Relationship *
Highest level of education completed
Secondary Parent/Guardian
First name
Last name
Sex
Address 1
Street address
Address 2
City
State
Zip
Email
Home phone
Alternative phone
Marital status
Relationship
Highest level of education completed
Emergency contact
Other than parent/guardian
First name *
Last name *
Relationship *
Home phone *
Alternative phone
Personal Statement
Copy and paste your 300-500 word personal statement (essay) into the space provided below. *
See description of what should be addressed at the bottom of http://www.cs.pitt.edu/tli/robotics.html
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms