Application  for  2018  High  School    Marine  Science  Summer  Lab  Experience  Program  Dates:  June  26  -­‐  July  2,  2018  

 Sponsored  by  USC  Sea  Grant,  USC  Wrigley  Institute  for  Environmental  Studis  &  C-­‐DEBI  (Center  for  Dark  Energy  Biosphere  Investigations)    All  applicants  must:  1) Complete  the  registration  form  below.  2) Attach  a  student  written  essay  (maximum  2  pages)  or  video  of  yourself  (maximum  5  minutes)  addressing:  a. Why  you  would  like  to  participate  in  this  program;  b. What  you  hope  to  gain  from  the  program  and  what  you  bring  to  share  with  other  participants;  and  

c. How  you  will  share  your  experiences  and  knowledge  from  the  program  with  your  community  or  school  after  the  program  

3) Include  a  letter  of  recommendation  from  a  teacher.  4) Attach  a  photo  (copy  is  fine)  of  yourself.  

 Application  deadline:  5  PM  on  March  9,  2018    Participant  Information    Name:__________________________________________________________________________      

Date  of  Birth:  __________________________________________________________________  

Street  Address:  ________________________________________________________________  

City:  _____________________________________        State:  __________        Zip:  _____________  

Home  Phone:  ___________________________________________________________________  

Email:  ___________________________________________________________________________  

       

Grade  level  in  fall  2018:  _________________  

School:  ____________________________________________________________  

Previous  camp  or  summer  program  experience:  

___________________________________________________________________________________  

 Demographic  Information    Gender:  ________________________________  

US  Citizen  or  green  card:    YES  _________        NO  ___________  

Disability:  YES  ____________        NO  _______________  

If  yes,  please  specify  any  accommodations  that  will  help  you  be  more  successful  in  the  program:  __________________________________________________________________________________    

Ethnic  Identity:  

________  Alaskan  Native  or  American  Indian  ________  Black  or  African  American  ________  Hispanic  /  Latino  ________  Native  Hawaiian  or  other  Pacific  Islander  ________  Multiracial  ________  White  or  Caucasian  ________  Other:  _______________________________________  ________  Decline  to  answer    

         Where  did  you  hear  about  this  program?  ___________________________________    Parent/Guardian  Information      Name:       ______________________________________      Relationship  to  participant:       ______________________________________  

 Street  Address:        

 City:       State:       Zip:        

 Home  phone:       email:        

 Signature:     _____________________________  

     Please  email  or  mail  application  and  materials  by  March  9,  2018  to:  sumprog.uscg@gmail.com  

 OR    USC  Sea  Grant  3454  Trousdale  Pkwy,  CAS  200  Los  Angeles,  CA  90089-­‐0373    

 Thank  you  for  your  interest  in  the    

High  School  Marine  Lab  Experience!