High School Men – Science Research Camp and Ethics
Workshop
Personal Information
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Name
Last First
Date of Birth
_________________________________________________________________
Address
(Street, City, ZIP Code)
_________________________________________________________________
(Home) Phone Number
_________________________________________________________________
Email
School
_________________________________________________________________
Institution Name
Grade
_________________________________________________________________
Address
(Street, City, ZIP Code)
_________________________________________________________________
Current GPA (or transcript)
Interests
Answer question or select one option:
Preferred activity: Working with scientist and attending Science
and Ethics Workshop
Only Science and Ethics Workshop
If you would like to work with a scientist, which
area(s) you like the most (please
select at least two areas):
What degree would you like to pursue in College?
What science courses are you taking or have taken in
the past?
Briefly explain your interest in the science club (use
additional page if necessary).
Send form to:
Summer
Science Research Camp