Millhill STEM Summer Explorers Program

Contact & Personal Information

Student's Name*

First Last

What Trenton Middle School do you attend?*

Who is your current science teacher?*

What do you like most about science and why?*

What science projects/experiments have you completed in school? Tell us about them.*

Have you participated in any science programs outside of your school? If so what did you like about them?*

If I asked your science teacher to tell me about you, what would your teacher say?*

What science TV shows or You Tube videos, if any, do you like to watch?*

Do you have a favorite scientist? If so what did they create or discover?*

Parent Section

Please have a parent or guardian complete this section

Parent / Guardian Name*

First Last

Address*

Street Address City State ZIP Code

Email*

Cell Phone*

Is your child able to attend the full 6 week program from July 6th - August 13th?*

Yes
No

Is you child able to attend program classes on Monday through Friday, 10:30 am - 2:30 pm, with a 30 minute lunch break?*

Yes
No

What is your child's date of birth?*

MM

DD

YYYY

What is your child's gender?*

Male
Female
Non-Binary / Gender Fluid
Other

What is your child's race/ethnicity?*

What grade will your child enter in Fall 2021?*

7th grade
8th grade
9th grade

Please select your annual household income range.*

Photo and video release*

I agree to have my child participate in STEM activity photos or videos. I understand that these photos/videos may be used for Millhill newsletters, publications, media publicity, including social media.
I do not give permission to have my child participate in STEM activity photos or videos.

By singing below, I give consent for my child to participate in the Millhill STEM Summer Explorers Program and will support their attendance and participation in this virtual training program.

*

Please use your cursor/mouse or finger (if you're on a phone or tablet) to sign in the space provided above.

Comments

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Millhill STEM Summer Explorers Program

Learn all about the STEM Summer Explorers program in this brief video. Applicant must be a Trenton resident who loves science and is entering 7th, 8th, or 9th grade in Fall 2021. Apply below!

Contact & Personal Information

Parent Section