TTU OUTDOOR STEM ACADEMY
Texas Tech University Outdoor STEM Academy (TTUOSA) is a unique experience
focused on developing student’s skills in science, technology, engineering and
mathematics (STEM) fields. TTUOSA is open to students who will be in the 7th, 8th
or 9th grade in the Fall 2014.
IMPORTANT DATES
CLASSES
As part of the academy, students will have the
opportunity to interact with professionals in a variety
of fields, build leadership, self-confidence and the
ability to work skillfully in teams. Students will
participate in indoor and outdoor educational and
leadership activities and learn more about their own
gifts talents and interests.
Classes are interdisciplinary and allow campers to
explore many aspects of science through the lens of a
scientific discipline. Curriculum will focus on an array
of STEM subjects, including ecology, agriculture,
environmental conservation, hydrology, astronomy
and ornithology.
Classes offer students exposure to award winning
interdisciplinary, collaborative student centered
curriculum. Course work will include several delivery
methods such as lectures, demonstrations,
experiments and in-field research. Students will also
have the opportunity to detail their experience
through discussions and roundtables.
LOCATION
TTUOSA is located in the beautiful Texas Hill Country
at the Texas Tech University Junction campus.
Transportation from Lubbock to Junction will be
provided.
ROOM AND BOARD
As part of the academy, students will be housed on site
at the campus. Housing is arranged by age and gender.
Daily meals will be served on campus as will snacks
and other refreshments.
■ Application Deadline:
June 6, 2014
■ Notification of Selection:
June 13, 2014
■ Student/Parent Orientation:
June 18, 2014
TUITION AND FEES
TTUOSA is offered free to all participants who are
selected to attend. To be considered for selection, all
interested students must complete an application. A
panel of educational professionals will review the
applications and the required autobiographical
statement and will select participants from the
applicant pool.
Participants will be notified on their selection and
given the opportunity to commit to attend. If a
participant chooses not to attend, their acceptance will
move to the next most qualified applicant.
All selected participants are required to attend
orientation with at least 1 parent or guardian.
JUNE 29TH – JULY 3RD 2014
For more information about the Junction campus can
be found online at:
http://www.depts.ttu.edu/junction/
OCE – Office of Community Engagement
OCE: (phone) 806.742.7017
community.oce@ttu.edu
www.community.ttu.edu
www.facebook.com/OCE
www.twitter.com/TTUOCE
Texas Tech University Outdoor STEM Academy Application
June 29th -June 3rd 2014
❏ To save resources, may we send program paperwork via email?
Email address
■ Please print clearly
Student’s Name
(First)
(Last)
Gender: ❏ M ❏ F Birthday Date______/______/______ Student SS# ________________________________________________
Grade in Fall 2014
__________________________________________________________
Mailing Address
City
State
Zip
Name of Parent of Guardian (Mother)
Home Phone (
)
Work Phone (
)
Cell Phone (
)
Cell Phone (
)
Name of Parent of Guardian (Father)
Home Phone (
)
Work Phone (
)
School Currently Attending
City
T-shirt size: ❏ Youth Small (6-8) ❏ Youth Med (10-12)
❏ Adult Medium
❏ Adult Large
❏ Youth Large (14-16) ❏ Adult Small
_________
Where did you hear about our program?
AUTOBIOGRAPHICAL STATEMENT
Required for all students applying. Using a separate Sheet of paper, please introduce yourself.
Include such things as your interests outside school, how you have spent your summers, what you
consider to be your strengths, why you feel you should be chosen for the Texas Tech University
Outdoor STEM Academy and what your hope to do after you graduate from high school. The
statement must be typed and should be at least 1 page in length, double spaced, and 12 point font.
OCE – TTUOSA
Texas Tech University • Doak Hall, Room 114
Box 45023 Lubbock, Texas 79404-5023
806.742.7017 • www.community.ttu.edu
Texas Tech University Outdoor STEM Academy
Medical History and Consent to Treat
Completion of the following, with a photocopy of proof of health insurance must be submitted with the
application. If this poses a hardship, call 806 -742- 7017.
Student’s Name
Name of Family Physician
Physician’s Phone No.

Copy of medical health insurance card is attached.
Directions: Check any medical conditions that apply and provide detailed information on all medical
concerns.
All information will remain confidential. If necessary, attach a separate sheet of paper to explain your child’s
medical condition or email additional information to: community.oce@ttu.edu
❏Conditions requiring medication
❏Allergies to food or medications
❏Current infections, viruses
❏Emotional or behavioral problems
❏Recent injuries, illness, operation
❏Impairment of sight, hearing, speech
❏Other
Consent to Medical Treatment
I,
, Parent, Managing Conservator, or
Guardian of
(Participant) hereby consent to any and
all emergency medical treatment needed by said Minor Child as administered by a clinic or attending
physician and accept responsibility for full payment of said treatment. I give my permission for this
document to be photocopied for medical personnel.
My child is enrolled in the Texas Tech University Outdoor STEAM Academy which will be held from June
29th to July 3rd 2014. My child is in the:
❏7th Grade
❏8th Grade
❏9th Grade
■
Signature of Parent, Managing Conservator, or Guardian
Date
This form is valid only for the 2014 session indicated above.
Texas Tech University Outdoor STEM Academy
Release and Hold Harmless Agreement
I,
, Parent/Managing Conservator/Guardian (circle one), understand that the minor
child,
has the opportunity to participate in
Texas Tech University outdoor STEM Academy, a program for students sponsored by Texas Tech University,
Office of Community Engagement, Lubbock Texas from June 29th – July 3rd 2014. I hereby affirm that I desire
to have my minor child participate in said program. I give my permission for my minor child to ride in public
transportation or in vehicles driven by Texas Tech employees or representatives to and from designated
activities. I, the undersigned, am aware of the dangers associated with travel by motor vehicle or other
conveyance and the possibility of injuries or death while in transit. I understand that my minor child will
participate in general classroom, educational, and camp activities during this program. I am aware of the
dangers associated with such activities and the possibility of injuries or even death in such participation. In
consideration of allowing my minor child to attend the above mentioned activities, I, the undersigned,
do hereby release, indemnify, and hold harmless Texas Tech University, its Board of Regents, all the
University’s officers, agents, and employees, and the Office of Community Engagement from any and
all liability due to injuries, damage or death arising or resulting from any act or omission, express
negligence or otherwise, of said Texas Tech University officers, advisors, agents, and employees and
other officers or members of the Office of Community Engagement, or any other person or participant
in said activities while attending the activities or while in transit to and from activities.
The terms hereof shall also serve as a release and an assumption of risk for my minor child’s heirs,
executor and administrator, and for all members of my child’s family and be pleaded as a bar to litigation.
Jurisdiction of this matter and venue shall lie in Lubbock, Lubbock County, Texas. I, the undersigned,
on behalf of my minor child agree to indemnify and hold Texas Tech University, its Board of Regents, and all
the University’s officers, agents and employees harmless from and against any and all personal injury. I am
above the age of eighteen (18) years and read this Release and Hold Harmless Agreement and voluntarily
understand and accept its terms.
Signature of Parent, Managing Conservator, or Guardian
Date
Print or type name of Parent, Managing Conservator, or Guardian
Media Coverage/Participation
I hereby give permission for the name of the minor listed above to be released to the media or for him/her
to participate in any media coverage which might transpire during the course of the program. I authorize
the use of the minor’s name, biography, likeness, voice and performance in the production of the
program(s) and for the purpose of publicizing and promoting the program(s).
I represent that I am a parent (guardian) of the minor whose name is listed above and I hereby agree to
have my child participate in media coverage.
❏ MY CHILD MAY PARTICIPATE IN MEDIA COVERAGE
Date
❏ MY CHILD MAY NOT PARTICIPATE IN MEDIA COVERAGE, and I do not wish his/her name released to
the news media.
Date
Texas Tech Outdoor School
Texas Tech University at Junction
Outdoor Academy Permission Form
Permission to attend:
I, as parent, guardian or managing conservator (circle one) grant permission for my minor child to participate in The South Llano River Center for
Outdoor Learning at Texas Tech University at Junction during the dates indicated. I understand that participation of my child is entirely voluntary and
optional on my part. I am aware of the dangers inherent in group activities. In consideration for my child being allowed to participate in this activity, I
agree to assume full responsibility for my child’s safety and medical treatment. I agree to release, indemnify and hold harmless Texas Tech
University, its Board of Regents, officers, agents and employees from any and all liability for personal injury including death or for damage to
property that may occur to my child or to others as a result of my child’s participation. The terms hereof shall also serve as a release and an
assumption of risk for my minor child’s heirs, executor and administrator and for all members of my child’s family, and may be pleaded as a bar to
litigation. Jurisdiction of this matter and venue shall lie in Lubbock, Lubbock County, Texas. I have read this Release and Hold Harmless agreement
and understand, and voluntarily accept, its terms. The privilege to go on this trip carries with it the obligation for a student to conduct him/herself in
such a way that credit will be reflected upon the student, school, and home represented. Correct dress and behavior for this trip will be observed.
Student’s Name: _____________________________________________________
School Name_______________________________________________________
Gender: Male or Female (circle one) Male
Parent/Guardian Name: _______________________________________________
Home Phone: ________________________ Cell phone: _____________________
Home Address:______________________________________________________
City_______________________________State___________Zipcode___________
Email Address: ______________________________________________________
*Parent Signature: ______________________________ Date: _________________
Publicity:
I hereby grant TTU Outdoor School staff permission to photograph my child for my enjoyment and for souvenir purposes. I
understand that by checking NO my child will not be included in the souvenir picture CD.
*Parent Signature: __________________________ Yes ____ / No ____ (check one)
Emergency Information:
Family Doctor: ______________________________ Phone: (____)_____________
Mother’s Name: ______________________________ Employer: _______________
Mother’s wk. hours: ______________________ Wk. Phone: (____)_____________
Father’s Name: ______________________________ Employer: _______________
Father’s wk. hours: ________________________ Wk. Phone: (____)____________
If, for some reason, I am not available at the above numbers, please contact:
(Please name a friend, relative or neighbor)
Name: __________________ Relation: ____________ Phone: (____)___________
Name: __________________ Relation: ____________ Phone: (____)___________
In case of accident, sudden illness, or in the event that I cannot be reached immediately by telephone, I hereby authorize the
attending adult to refer this child to the above named doctor, emergency facility and/or Kimble County Hospital. I further instruct the
above named heath care providers and/or Kimble County Hospital to grant my designees the power to act in loco parentis until such
time as I can assume responsibility. I further understand that just as at my child’s school, medical care is my financial responsibility.
*Parent Signature: ______________________________ Date: _________________
The South Llano River Center for Outdoor Learning
Texas Tech University at Junction
Outdoor Academy Information Sheet
The South Llano River Center for Outdoor Learning is devoted to creating innovative educational
programs. We provide a setting where children become engaged with the natural world and
discover the joy of learning. We immerse learners in authentic, hands-on activities that stimulate
imagination, develop a curiosity about life and create an environment to share discoveries.
The Outdoor School is staffed by certified teachers who work with your child’s classroom teacher to
monitor and care for your child for the duration of their stay.
Why should your child go to The Outdoor School?
 The Outdoor School is an extension of the classroom and is important in preparation for
your child’s middle school years.
 The programs are designed to reinforce your child’s fifth grade curriculum.
 The Outdoor School has a strong relationship with superintendents, curriculum directors,
principals and teachers in order to design programs that meet state educational standards
and develop the leaders of tomorrow.
The students will attend The Outdoor School for 2 to 4 days. During this stay, students will
become scientists: Astronomers, Ornithologists, Aquatic Biologists, and Pedologists. Students will
collect and record data throughout their stay.
Will my child receive excellent physical care?
 Yes, the facilities provide heating and cooling for comfort.
 Yes, there are nutritious meals served in a wonderful dining hall.
 Yes, the instructors will assure that children get rest and have a clean environment.
 Yes, if your child has any special health problems such as allergies, diet, medicine or
sleepwalking, he/she will be properly cared for in the time of need.
The matter will be kept confidential.
We are sorry, but parent visits are discouraged at The Outdoor School due to possible interruptions
of scheduling and instruction. If you have an emergency or any questions, please call:
Day: 325-446-2301, Evening: 262-492-3527. Feel free to mail your child a letter; but mail early!
Mail cards and letters the weekend before your child attends the TTU Outdoor School.
Child’s Name
School & Teacher
TTU Outdoor School
PO Box 186
Junction, Texas 76849
Needed Clothes and Equipment
PLEASE LABEL all equipment and clothing with your child’s name. Students will be outdoors, so be
prepared for any type of weather. Clothing for TTU Outdoor School should be rugged and informal. All
events
at
TTU
Outdoor
School
are
informal.
BEDDING
[]
Pillow with pillow case and bedding (sleeping bag or sheet with blanket) wrap bedding in a PLASTIC BAG so that it stays clean and dry
CLOTHING AND PERSONAL ITEMS
[]
Clothes for 2 days only (1 extra outfit)
[]
Long pants (jeans, rugged pants, please, no shorts outdoors)
[]
Sweatshirt/windbreaker/jacket for evenings
[]
Underwear 2-3 pair (extra pair)
[]
Socks 4 – 5 pair (extra socks in ziplock bag for the river)
[]
Closed toe shoes (extra pair suitable for wearing in the river) – please, no flip flops outdoors
[]
Sleepwear (pajamas, sweats, t-shirt and shorts – accepted for sleepwear)
SHOWER NEEDS
[]
Toiletry articles (deodorant, soap in container or zip-lock, toothpaste, toothbrush, shower
cap if needed, comb/hair brush, any need for personal hygiene)
[]
Flip-flops or Shower Shoes Needed for Bath House
[]
Washcloth and towel
OTHER NEEDS
[]
Rain gear (poncho) – send one just in case
[]
Mosquito Repellent and/or TICK repellent with DEET
[]
Seasonal Items (coat, gloves, hat and long underwear)
[]
Self addressed stamped envelope(s), pen and stationary for writing letters
[]
Disposable Camera – of course you can take pictures
[]
Garbage Bags for dirty clothes and wet clothing
[]
Flashlight (optional)
[]
Hat/Cap or Visor is a good idea
[]
Sunscreen and Chap Stick/Lip Balm with SPF
[]
Money for souvenirs (if school permits)
Please do NOT bring:
 Anything electric (hair dryers, curling irons, etc.) We have hair dryers.
 Electronic items (Handheld gaming devices, CD players, IPods, games, Cell Phones, etc.)
 Food (including candy and gum)
 Soft Drinks (Milk, Lemonade, Water and Juice are provided)
 Pocket knives or any sharp tool
 Large amounts of money
 Make-up, jewelry, nail polish, perfume, cologne and razors
Texas Tech Outdoor School
Texas Tech University at Junction
Student Behavior Guidelines
Rights and Expectations:
We believe all students have the right to a quality outdoor experience. We also
believe that, as teachers, we are entitled to instruct students without interruptions
due to poor student behavior. Please sign below, stating that you and your child
have read and understood the following guidelines, consequences and procedures.
Guidelines:
1. Students should be attentive and actively participate.
2. Students should respect the rights of others and their property.
3. There is no horseplay or fighting.
Consequences and Procedures:

The student is given a verbal warning.

The student will lose the right to participate in an activity.

The student will be sent to their home or school campus.
Fighting and Stealing are automatic causes for the student to be sent to home
or to their school campus at their parents’ expense.
* Parent Signature: ______________________________ Date: _______________
**Student Signature: _____________________________ Date: _______________
Texas Tech Outdoor School
Texas Tech University at Junction
Medications and Special Concerns


If your child is not taking medications, please write NONE and sign where indicated.
ALL medications must be in the original bottle from pharmacy and dosage must be current.
Student’s Name ____________________________ Male or Female (circle one)
Female
Please share special information about your child including allergies, food allergies, special dietary
concerns, sleepwalking, nocturnal incontinence, allergies to bug spray, etc:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Directions for Administering Medications (Please Print):
Medicine Name
Breakfast
Lunch
and Dosage
Time
Time
Dinner
Time
Bed
Time
Any medicine explanations:
______________________________________________________________________________________
______________________________________________________________________________________
(if you need more writing space, please attach a sheet of paper)
I/We hereby request, and give permission to TTU Outdoor School staff, medical personnel,
Kimble County Hospital and/or appropriately trained teachers to administer medication
and/or aid.
*Parent Signature: __________________________ Date: ___________________
Doctor’s special instructions (if needed):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Doctor’s Name: _______________________________________ Phone: ___________________
Doctor’s Signature: ____________________________________ Date: _____________________