Summer Workshop Application

APPLICATION FOR HIGH SCHOOL STUDENTS

SUMMER WORKSHOP IN ATMOSPHERIC, EARTH AND SPACE SCIENCES

NAME _____________________________________________ BIRTHDATE_____/_____/_____ SEX: M____F____

HOME ADDRESS

_________________________________________________________________________

HOME TELEPHONE ( ____ )_____________________ SOC. SEC. #. (Optional):_____________________________

EMAIL ADDRESS:______________________________________________ T-SHIRT SIZE:_______________

ETHNIC BACKGROUND (Optional):

EUROPEAN____AFRICAN-AMERICAN____HISPANIC____NATIVE AMERICAN____OTHER (INDICATE)______

NAME OF PARENT OR GUARDIAN ________________________________ Parent EMAIL __________________________

SIGNATURE INDICATING PERMISSION TO ATTEND* ___________________________________________

* Students: We are unable to consider your application without the consent of a parent or guardian.

HIGH SCHOOL

NAME _______________________________________________________________________

ADDRESS
_________________________________________________________________________

_________________________________________________________________________

SCIENCE TEACHER'S SIGNATURE (This should be a teacher who is familiar with the quality of your work)

______________________________________________________ Subject(s) taught ________________________________

STUDENT
List high school science courses, year taken & grade received (include current courses)

_____________________________________________ ______________________________________________

HIGH SCHOOL GRADE POINT AVERAGE ______________________

WHAT ARE YOUR FIELDS OF INTERESTS IN SCIENCE?

LIST ANY SCIENCE-RELATED ORGANIZATIONS, PROJECTS, AWARDS, OR ANY OTHER INFORMATION YOU FEEL WOULD BE RELEVANT TO THIS APPLICATION.

ON A SEPARATE PAGE, PLEASE INDICATE WHY YOU WOULD LIKE TO ATTEND A SUMMER WORKSHOP IN EARTH AND ATMOSPHERIC SCIENCES. PLEASE NOTE THAT PARTICPATION IN THIS WORKSHOP HAS BECOME VERY COMPETITIVE AND YOU SHOULD GIVE SPECIAL ATTENTION TO THIS NARRATIVE!

FOR FURTHER INFORMATION CONTACT MARIA VASYS AT 608/263-7435

APPLICATION DEADLINE: 30 April 2009

MAIL APPLICATION (including a signature from one of your science teachers and your essay) WITH $75 DEPOSIT.
Checks should be made payable to SSEC or call for payment via credit card. The remaining balance of $400 is due on 5 June 2009.
Fees cover housing, food, a T-shirt, and transportation for field trips.

MARIA VASYS

SSEC at UW-MADISON

1225 W. DAYTON STREET

MADISON, WI 53706

(608) 263-7435