Applicationfor2016HighSchoolMarineScienceSummerLabExperience
ProgramDates:July7-13,2016
SponsoredbyUSCSeaGrant,USCWrigleyMarineScienceCenter,CDEBIAllapplicantsmust:1) Completetheregistrationformbelow.2) Attachastudentwrittenessay(maximum2pages)orvideoofyourself(maximum5minutes)addressing:a. Whyyouwouldliketoparticipate;b. Whyyouwouldliketobeselectedforthisprogram;andc. Howyouwillsharewhatyoulearnedfromthisprogramafteritisover.
3) Includealetterofrecommendationfromateacher.4) Attachaphotoofyourself.
Applicationdeadline:5PMonMarch25,2016ParticipantInformationName:__________________________________________________________________________
DateofBirth:__________________________________________________________________
StreetAddress:________________________________________________________________
City:_____________________________________State:__________Zip:_____________
HomePhone:___________________________________________________________________
Email:___________________________________________________________________________
Gradelevelinfall2016:_________________
School:____________________________________________________________
Previouscamporsummerprogramexperience:
___________________________________________________________________________________
DemographicInformationGender:________________________________
USCitizenorgreencard:YES_________NO___________
Disability:YES____________NO_______________
Ifyes,pleasespecifyanyaccommodationsthatwillhelpyoubemoresuccessfulintheprogram:__________________________________________________________________________________
EthnicIdentity:
________AlaskanNativeorAmericanIndian________BlackorAfricanAmerican________Hispanic/Latino________NativeHawaiianorotherPacificIslander________Multiracial________WhiteorCaucasion________Other:_______________________________________________Declinetoanswer
Wheredidyouhearaboutthisprogram?___________________________________Parent/GuardianInformationName: ______________________________________ Relationshiptoparticipant: ______________________________________
StreetAddress:
City: State: Zip:
Homephone: email:
Signature: _____________________________
PleaseemailapplicationandmaterialsbyMarch25,2016to:[email protected]
Orsendbypostto:USCSeaGrant3454TrousdalePkwy,CAS200LosAngeles,CA90089-0373Thankyouforyourinterestinthisprogram!
