2018 Summer STEM Academy

ACADEMY INFORMATION//

Dates:
June 11 - July 12, 2018

Cost:
Free - in fact, students who complete the five week Academy program, with at least an 85 percent attendance rate (maximum of three absences) and all projects finished and submitted, will receive a certificate and a stipend.

Requirements:
Must be an incoming high school senior, incoming college freshman or current college student from Donnelly or any institution.

Location:
Donnelly College
608 N. 18th Street
Kansas City, Kansas 66102

Deadline:
Applications will be accepted Monday, May 7 through Friday, June 1, or until all spots are filled.

Note: Not all applicants will be selected to participate in the academy. If you are selected to participate, you will be notified by email in June.

STUDENT INFORMATION
Date Date / MM / DD YYYY
Name Name First Last
Social Security Number
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Primary Phone Primary Phone - ### - ### ####
Secondary Phone Secondary Phone - ### - ### ####
Email

(We will be contacting you via email)
Date of Birth Date of Birth / MM / DD YYYY
Age
Name of School
Incoming Grade Level in School
Projected Graduation Year from High School
Gender
Ethnic Origin
Short Essay:
Why do you want to attend Donnelly College's Summer STEM Academy?
Maximum of 500 words allowed. Currently Entered: 0 words.
Relationship
Emergency Contact

Whom would you like to be contacted in the event of an emergency?
Name Name First Last
Relationship
Phone Number Phone Number - ### - ### ####
Work Phone Work Phone - ### - ### ####
I understand that in an emergency, I will be contacted as soon as possible at the above numbers. If I am not available, I have provided an alternate contact number.

I understand that in an emergency, I will be contacted as soon as possible at the above numbers. If I am not available, I have provided an alternate contact number. Yes

2018 Summer STEM Academy

2018 Summer STEM Academy

STUDENT INFORMATION

Emergency Contact