application 2016 high school summer marine lab...application for 2016 high school marine science...

Applicationfor2016HighSchoolMarineScienceSummerLabExperience

ProgramDates:July7-13,2016

SponsoredbyUSCSeaGrant,USCWrigleyMarineScienceCenter,CDEBIAllapplicantsmust:1) Completetheregistrationformbelow.2) Attachastudentwrittenessay(maximum2pages)orvideoofyourself(maximum5minutes)addressing:a. Whyyouwouldliketoparticipate;b. Whyyouwouldliketobeselectedforthisprogram;andc. Howyouwillsharewhatyoulearnedfromthisprogramafteritisover.

3) Includealetterofrecommendationfromateacher.4) Attachaphotoofyourself.

Applicationdeadline:5PMonMarch25,2016ParticipantInformationName:__________________________________________________________________________

DateofBirth:__________________________________________________________________

StreetAddress:________________________________________________________________

City:_____________________________________State:__________Zip:_____________

HomePhone:___________________________________________________________________

Email:___________________________________________________________________________

Gradelevelinfall2016:_________________

School:____________________________________________________________

Previouscamporsummerprogramexperience:

___________________________________________________________________________________

DemographicInformationGender:________________________________

USCitizenorgreencard:YES_________NO___________

Disability:YES____________NO_______________

Ifyes,pleasespecifyanyaccommodationsthatwillhelpyoubemoresuccessfulintheprogram:__________________________________________________________________________________

EthnicIdentity:

________AlaskanNativeorAmericanIndian________BlackorAfricanAmerican________Hispanic/Latino________NativeHawaiianorotherPacificIslander________Multiracial________WhiteorCaucasion________Other:_______________________________________________Declinetoanswer

Wheredidyouhearaboutthisprogram?___________________________________Parent/GuardianInformationName: ______________________________________ Relationshiptoparticipant: ______________________________________

StreetAddress:

City: State: Zip:

Homephone: email:

Signature: _____________________________

PleaseemailapplicationandmaterialsbyMarch25,2016to:seagrant@usc.edu

Orsendbypostto:USCSeaGrant3454TrousdalePkwy,CAS200LosAngeles,CA90089-0373Thankyouforyourinterestinthisprogram!