STEM Academy Application 2020

ALLIES in STEM Academy Application Form

60 W. Olsen Road #5200
Thousand Oaks, CA 91360
(805) 493-3701
academy@callutheran.edu
www.callutheran.edu/academy

STEM Academy Program Application

California Lutheran University (Cal Lutheran) and the ALLIES in STEM Program are proud to sponsor student participation in the STEM Academy. We invite students from all underrepresented backgrounds (including but not limited to gender, race, sexual orientation, or disability) to apply to the STEM Academy.

First Name

Preferred First Name

Last Name

Email Address

Birthdate

Are you Hispanic or Latino?

Yes

No

Regardless of your answer to the prior question, please indicate how you identify yourself. (To select multiple, please hold ctrl and select)

Mobile Number

May we text you important updates about the STEM Academy and Cal Lutheran?

Text Message Number

Are you a current High School Student or a Community College Student??

Current or most recent school attended (add the city to help narrow results)

CEEB Code

What year do you graduate high school?

Applications for STEM Academy 2020 are no longer being accepted from High School applicants. Thank you for your interest and we hope to see your application next year.

Do you plan on attending a Community College or a 4-year University for the upcoming Fall semester?

Applications for STEM Academy 2020 are no longer being accepted from First Year applicants. Thank you for your interest and we hope to see your application next year.

What Community College do you plan on attending this Fall?

When are you planning to enroll at a four-year college or university?

Which major are you interested in?

Mailing Address

Country

Street

City

Region

Postal Code

Academic Level of Interest

Interaction Code

Gender

Gender Details

How did you find out about the STEM Academy?

Please specify what event

Please specify

Have you applied to the California Lutheran University STEM Academy before?

Yes

No

What year did you previously apply to CLU's STEM Academy?

Have you applied for admission to Cal Lutheran for Fall 2020?

Yes

No

Have you been admitted to Cal Lutheran for Fall 2020?

Yes

No

Are you a 1st generation college student (i.e. Your parents have NOT earned a bachelors's degree)?

Yes

No

Do you, your parents, or anyone in your parents' household receive benefits from any of the federal programs listed? (Mark all that apply)

Medicaid or Supplemental Security Income (SSI)

Supplemental Nutrition Assistance Program (SNAP)

Free or Reduced Price School Lunch

Temporary Assistance for Needy Families (TANF)

Special Supplemental Nutrition Program for Woman, Infance, and Children (WIC)

Board of Governors (BOG) Fee Waiver

Pell Grant

Are you part of or planning to apply to any of the following programs:

Additional Questions

Disclaimer: The following information will not be used in the admission decision, but rather be used to provide you with needed services.

Do you have any disabilities or medical concerns that will require accommodation? (If yes, and admitted to program, we encourage you to reach out to Cal Lutheran's Disability Support Services at (805) 493-3464.)

Yes

No

Do you have any food/dietary considerations?

Yes

No

Please explain:

Are you planning to attend summer school?

Yes

No

What dates and where do you plan to attend summer school?

Supplemental Application Requirements

Which aspects of STEM (Science, Technology, Engineering, Math) interests you and why? (150 word max)

Please provide an example of when you worked with a group of people. What role did you play? How did you deal with differences of opinion? How did you contribute to the goals of the group?? (250 word max)

Upload Transcript

Please upload your most updated high school or community college transcript (unofficial or official accepted)

Recommendation

Please provide contact information for a teacher/professor or counselor who will provide a letter of recommendation for you. Please note - an official recommendation form will be emailed to the name/email you provide.

Name:

Title:

Phone Number:

Email:

I acknowledge it is my responsibility to ensure a letter of recommendation is submitted on my behalf. This letter is due June 1, 2020.

Yes

Acknowledgement

I understand that if selected as a STEM Academy participant, the personal information provided will be protected by the Family Education Acts and Privacy Act (FERPA), and will be kept confidential. If accepted, and for continued program participation, I authorize California Lutheran University ALLIES in STEM program to receive copies of my transcripts, grade reports, financial award letters, and other records necessary for application review. If I choose to attend the STEM Academy, I recognize that I will be required to fully participate in the program as well as attend all three weeks of the STEM Academy in order to receive the three credits. In addition, I hereby give permission for my name, photograph, research, and/or statements to be used by the ALLIES in STEM program for promotional, publicity, and/or instructional purposes.

By initializing below, I am confirming that all information contained within this application is complete and accurate to the best of my knowledge.

Initial:

Applicant Digital Signature:

Date:

Are you 23 years old or younger? If so, a parent signature is required

Yes

No

Parent/Guardian Digital Signature:

Date: