Winter/Spring STEM Registration Winter/Spring 2017 Participant Application Ground Drone Assembly & Arduino Coding Thank you for your interest in the STEM enrichment programs presented through the partnership of S.T.E.M. Community Outreach and the Laurel-Jones County Library. To be considered for program participation, please complete all sections of the application, which includes a short answer questionnaire on back. Application submission deadline is Wednesday, January 10, 2018. Selected participants will be notified of selection on Friday, January 12, 2018, via phone and email. All questions regarding program details and application should be emailed to firstname.lastname@example.org Program InformationProgram of Choice (check one):*Grades 3-5 (Ages 8-11)Grades 6-8 (Ages 11-14)Select preferred session for participation (check one):*Winter SessionSpring SessionOpen to EitherWinter Session Dates Grades 3-5: Tuesdays, Jan. 16 – Feb. 20 at 3:30-4:30pm Grades 6-8: Thursdays, Jan. 18 – Feb. 22 at 3:30-4:30pm Spring Session Dates Grades 3-5: Tuesdays, March 20 – April 24 at 3:30-4:30pm Grades 6-8: Thursdays, March 22 – April 26 at 3:30-4:30pmStudent InformationStudent Name* First Middle Last School*Grade Level*Age*Gender*MaleFemaleEthnicity*African AmericanAsianCaucasianHispanicNative AmericanFamily Type*1-Parent2-ParentNon-TraditionalParent/Guardian InformationName* First Last Gender*MaleFemaleHome Phone*Cell Phone*Work Phone*Home Address* Street Address Address Line 2 City ZIP / Postal Code Email* Other Parent/Guardian (if applicable)Name First Last GenderMaleFemaleHome PhoneCell PhoneWork PhoneHome Address Street Address Address Line 2 City ZIP / Postal Code Email Household InfoAnnual Family Income (will not be shared):*$0-$23,550$23,551-$74,500$74,501 and aboveHousehold Size*SignaturesStudent Signature*Please print nameDate* Parent Signature*Please print nameDate* Short Essay QuestionsINSTRUCTIONS: The questions below are designed to give us insight about your interest in science, technology, engineering, and math (STEM). Please use the space below to answer the following questions. Answers must be written in a neat and clear manner using complete sentences.What to do want to become when you graduate from high school? Feel free to talk about college, military, or technical school plans.How can learning about science, technology, engineering, and math (STEM) make you a better student?List five words you think best describe you.If you could invent something that would make life easier for people, what would you invent?