Application Form – TEST – Coca-Cola Space Science Center

In this application you will need:

Student information
Emergency contact
Extra curricular description(s)
3 goals for camp
500 words on why you should be selected and how it would help you accomplish your goals
Student-guardian contract

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Space Robotics Summer 2022 Program Application

Student Information

Name*

First

Last

Address line 1*

Address line 2

City*

State*

Zip code*

Email address*

School*

Grade level for 2022-2023 school year*

Date of Birth

Month*

Day*

Year*

Do you have any food restrictions?*

Please tell us about your restrictions

Emergency Contact

Name*

Phone Number*

In what extra-curricular activities do you/have you participate(d)?*

List three goals that you will achieve as a result of attending this summer camp.*

In 200 words or less, please explain why you should be selected to attend the One Giant Leap into Your Future: Applications of Space Robotics summer camp and describe how attending this camp will assist you with your future goals. If you would like to type your answer in a separate document, upload it below.*

Do you have any skills with computer programming, design, collaboration with your peers, etc.? (The answer to this question will not affect your selection for participation in camp.)*

Please list those skills.*

Educator Reference

Name*

First

Last

Email address*

Space Robotics
Summer 2022 Program Application

STUDENT-GUARDIAN CONTRACT

Being selected as a participant in the Space Robotics summer program is a special opportunity for students to be introduced to fundamental concepts in robotics and aerospace engineering. This valuable training can help students prepare for important careers in STEM related fields. The seats in this program are limited and are being funded by a donor. If your student is selected and accepts this opportunity, the student and their guardian(s) need to assure attendance within reasonable expectation.

Guardian

Name*

First

Last

Guardian relationship to applicant*

Phone Number*

Email address*

By typing my name below, I agree that if my child is selected to participate in this summer program that I will ensure that he/she attends for the entire period. All costs for the summer program will be borne by a donor.

Signature*

Student

Name*

First

Last

By typing my name below, I acknowledge that if selected I am making a firm commitment to participate in this summer academy program. I understand that attendance is important because the cost of the summer program is being borne by a donor.

Signature*

This field should be left blank