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):