Junior STEM Academy Registration 2021 Virtual Junior STEM Academy Registration Please Selected which JSA program you are applying for: * RequiredK - 2nd Graders3rd Graders4th and 5th Graders1. Student InformationName of Scholar * RequiredApplicant name First Middle Last Gender * RequiredFemaleMaleGender Non-conformingAge * RequiredRace/Ethnicity * RequiredPlease check all that apply. This is for statistical purposes only. American Indian or Alaska Native Asian American Black or African American Hispanic or Latino Native Hawaiian or Pacific Islander White or European American Nation/Country of OriginThis is for statistical purposes only.Scholar Address * Required Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Scholar Cell PhoneScholar EmailWe look forward to continuing conversations with our scholars. Please share the email on which they can be reached. (student email preferred, all mass correspondence is also sent to parent/guardian) 2. Student EducationGrade Level * RequiredPlease select the grade level for 2019-2020 school year.Kindergarten1st grade2nd grade3rd grade4th grade5th gradeSchool Name * RequiredPlease share applicant's current school.School Address * Required City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State 3. Parent/Guardian InformationParents and guardians of the scholar, please enter your information under this section.Parent/Guardian Name * Required Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Relationship to the Scholar * RequiredOther parent or GuardianYou are welcome to list any additional parent or guardian.Parent Address * Required Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent Cell Phone * RequiredPlease share best contact number.Additional Phone NumberYou are welcome to provide any additional number.Parent Email * RequiredImportant information regarding this program will be sent to you via email. 4. Additional Scholar InformationDoes/should your scholar receive free or reduced lunch at school?This information is necessary to assist us with scholarship determinations, data, etc. We appreciate your cooperation. For questions concerning eligibility. https://www.fns.usda.gov/nslp/national-school-lunch-program-nslpYes, free lunchYes, Reduced lunchNo, my child does not receive free or reduced lunch.1st Career Choice * Required2nd Career Choice * RequiredExtracurricular Activities and Interest * RequiredPlease briefly list the activities that the student has or is currently participating. Additionally, please briefly list any academic and/or social clubs of the scholar.Select appropriate camp for your scholar. * RequiredPlease select an appropriate camp for your scholar. JSA 1- Kindergarten-2nd Grade JSA 2- 3rd Grade JSA 3- 4th Grade- 5th Grade Returning StudentHas your scholar, or sibling of applying scholar, previously attended Junior STEM Academy?YesNoWho previously attended?Please share who previously attended JSA.Applying scholarSibling(s) of ScholarBothName and Dates.Please share the name and year scholar, or siblings attended JSA.T- Shirt SizePlease choose the size for your childSmall (7-8)Medium (8-10)Large (12-14)XL (16+)Adult SmallAdult MediumAdult LargeAdult XLAdult XXLOtherPlease choose white coat sizePlease choose coat size for your child. The white lab coats are snug but should allow for range of motion. The coat buttons down the front.Small (7-8)Medium (8-10)Large (12-14)Extra Large (16+)Adult SmallAdult MediumAdult LargeAdult XLAdult XXLBy clicking "Submit", you agree that: 1. Both the student and parent(s) have read the program description and agreed to its content and rules, and 2. The information provided in this application is both complete and accurate.
