Aerospace Engineering Camp Summer Program 2016 Texas State University Student Application with Student Consent Form Date: ____________________ Student’s Name: ___________________________ Date of Birth: ____/___/____ mm /dd /yyyy Select the summer camp you are applying for based on your entering grade level for Fall 2016 (next school year): Mark only one Camp Dates 3rd Grade: July 5 – July 9 4th Grade: July 11 – July 16 5th Grade: July 11 – July 16 6th Grade: July 18 – July 23 7th Grade: July 25 – July 30 8th Grade: Aug 1 – Aug 6 Have you attended the Little Engineers camp in the past? If yes, how many times?_______________ Yes No Name of School in the Fall 2016 (next school year): School Gender: Male Female Primary Language Spoken at Home: English Spanish Other (please specify): How did you hear about this Summer Program? Teacher Flyer/other advertisement T-shirt size (for advance ordering): o Small You th o Medium Yo uth o Large Youth o Small Adult o Medium Adult o Other: El Centro Other (please specify): PARENTS, PLEASE ANSWER BELOW: What is your race/ethnicity? o White o Black/ African American o Hispanic / Latino o American Indian/Alaskan Native o Asian o Native Hawaiian or other Pacific Islander o Multiracial o I prefer not to reply What is your highest level of education completed? o Less than high school o High school graduate or GED o Some college o 2-year degree o 4-year degree o Graduate Education (Masters or Doctoral) o I Prefer Not to Reply Background Information about Your Child: What is your child’s favorite subject in school? o Art o Gym/ Physical Education o Mathematics o Music o Reading o Science o Social Studies o Writing o Social Studies o Don’t know Which of the following careers, if any, do you think your child would like to pursue? o Actor/ Musician/Performer o Artist or Designer o Business Executive o Doctor/ Dentist o Engineer or Computer Scientist o Entrepreneur o Financial Professional o Lawyer o Mathematician or Scientist o Military Personnel o Professional Athlete o Teacher o No Preferences / Don't Know How influential do you think you will be on your child’s future career path? o extremely influential o very influential o somewhat influential o not at all influential Which of the following careers, if any, would you like your child to pursue? o Actor/ Musician/Performer o Artist or Designer o Business Executive o Doctor/ Dentist o Engineer or Computer Scientist o Entrepreneur o Financial Professional o Lawyer o Mathematician or Scientist o Military Personnel o Professional Athlete o Teacher o No Preferences / Don't Know Did your family qualify for the free or reduced lunch program during the 2015-16 school year? o o o Yes No Not Applicable/ Don’t want to answer My child has my permission to attend this summer program. I will make sure that my child attends all sessions. I also hereby authorize program staff to photograph and videotape my child for educational and program promotional purposes. Parent or Guardian Name: _____________________________________________________________________ Parent or Guardian Signature: _____________________________________________________________________ Contact Information Email: Phone: Preferred language: STUDENTS, PLEASE ANSWER BELOW: What is your favorite subject in school? What kind of job would you like when you grow up? Why do you want to go to this camp? Aerospace Engineering Summer Program 2016 Texas State University- San Marcos Centro Cultural Hispano de San Marcos and LBJ Institute for STEM Education and Research 2016 Student Consent Form Date: Student’s Name (please print): Student’s Program ID Number (assigned by program): Parent/Guardian’s Name ____________________________________________________________ Texas State University will be using student data to evaluate the effectiveness of this program. All data is confidential. It will be reported only in the aggregate and for the express purpose of measuring and reporting on the effectiveness of this program. I/we understand that any such information will be used by Texas State University only for these purposes, that Texas State University will not disclose any such information that personally identifies a student to any other party, and that any report generated on the basis of this information will not personally identify any student. Parent or Legal Guardian Parent Phone number: _________________________________ Parent email (if available):