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1.
Last Name
2.
First Name
3.
OHIO Email Address
4.
Preferred Email Address
5.
Contact Phone
6.
Declared Major
7.
Highest Math Taken
8.
Have you taken any college classes while in high school?
Yes
No
9.
If you answered yes above, list all the courses that apply
10.
What excites you about the STEMstart program?
11.
What do you expect to get out of the STEMstart program?
12.
List your State and you County (Example: Ohio, Franklin County)
13.
Can you commit to participating in all of the program activities the week of STEMstart?
Yes
No
14.
If you answered 'No' above, list any prior commitments that would not allow you to attend All STEMStart functions between August 16th – 22nd:
15.
What size shirt do you wear?
Small
Medium
Large
16.
Do you have any dietary restrictions? Please describe:
17.
Will you be under the age of 18 when participating in STEMstart?
Yes
No
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