NKU CINSAM Summer Camp 2009 Application
Camp
JAVA Camp
Women in Engineering
Engineer's Camp
Middle School Emerging Technologies Camp
Astronomy Camp
Astronomy Camp
Fun with Science Camp
Aeronautics Camp
CSI III
High School Emerging Technologies Camp
Math/Statistics Camp
Date
June 8-July 8
June 15-19
June 22-26
July 6-10
July 6-10
July13-17
July 13-17
July 20-22
July 20-24
July 27-31
July 27-31
Time
12:00-4:00
9:00-3:30
9:00-3:30
9:00-4:00
1:00-4:00
1:00-4:00
12:00-4:00
1:00-4:00
12:00-4:00
9:00-4:00
12:00-4:00
Fee
$25
$75
$75
$0*
$0*
$0*
$25
$25
$25
$0*
$25
Grade Level
9th-12th
9th-12th
9th-12th
6th-8th
6th-8th
6th-8th
6th-8th
6th-10th
CSI II attendees and 10th-12th
9th-12th
6th-8th
*Funded by a Grant
Student Application Form
Camp:______________________________ Date:________________ Fee:________
Name of Student:
First: ___________________________________Last:__________________________________
Street: __________________________________City:_________________________________
State: __________
Zip: _____________
Phone: ______________________
Email (optional): ___________________________
Grade (as of the start of school in the fall of 2008) __________
Name of School: ______________________________________________________________
Street: _________________________________
State: _______
City: ______________________________
Zip: ________
Name of Recommending Teacher:
First: _________________________________ Last: _________________________________
Teacher Email: _________________________
Daytime Phone: ____________________
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Parent/Guardian Information :
First Name: ________________________________Last Name: _________________________
Primary Phone: _______________________Emergency Phone: _________________________
Cell Phone: (optional)__________________ Parent Email (optional)______________________
Does this participating student have any physical limitations, health conditions, or allergies (including food
allergies) of which camp leaders should be aware? Will the student require any special assistance?
_____Yes _____No
If yes, please explain:
Students may be surveyed before, during, and after the camp. The surveys will question student knowledge and
attitudes especially related to the topics offered in the camp. The completely anonymous results of these
surveys may be used in professional publications, grant applications, CINSAM publications, and/or
presentations. Does CINSAM have permission for this student to be surveyed?
_____Yes _______No
Students may be photographed during the camp. These images may be used in CINSAM publications and/or
presentations. Does CINSAM have permission for this student's photograph to be so used?
_____Yes _______No
Parents/guardians must arrange for transportation to and from the camp. State who will be picking up this
student at the camp dismissal time. CINSAM must be made aware in advance (572-5381) of any alternative
arrangements that might occur during the days of the camp.
Name: _______________________ Relationship to Student: ___________ Phone:__________
Statement of permission from the parent or guardian:
_____________________________________ is applying to attend the ___________________ Camp.
This student and I understand that proper behavior and participation while taking part in this camp are
essential and expected of each and every student. This application has been made with my knowledge
and approval as the named student's parent or guardian. I, as the parent or guardian, further state that
all data in the application concerning this student are accurate.
Parent/Guardian Signature: ___________________________________ Date________
Parent/Guardian Name (Please Print): ________________________________________
Your completed application must be received in the CINSAM office no later than May 22, 2009
to be considered for participation.
Each camp has limited enrollment. Campers will be selected (by lottery if necessary) from applicants with a
completed application received no later than May 22, 2009. Campers will be notified soon after May 11 and the
camp fee will be due by the date indicated in the notification to hold the camper’s place. Camper scholarships
are available for cases of need; for more information, contact Betty Stephens at 859-572-1308 or by email at
stephensb@nku.edu.
Mail the application to:
Ms Heather Howard, Academic Assistant
CINSAM at NKU
519 Founders Hall
Nunn Drive
Highland Heights, KY 41099
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IMPORTANT
To the Student Applicant: To complete your application, i.e., the following items for the camp,
you must send these by mail to be received in the CINSAM office no later than May 22, 2009 in
order to be considered for participation in your camp(s) of choice.
1.
The Student Application form completed
2.
Parent/Guardian Information completed and signed by a parent or guardian.
3.
A short essay (one page) stating why you, the student participant, wish to attend and participate
in this camp. Write this short essay on a separate page using complete sentences, well
constructed paragraphs, and with emphasis on how participation in this camp will benefit not
only your improved knowledge of science and mathematics topics, but also how you will
contribute to the whole of the camp’s achievements.
4.
A signed and completed recommendation form from your science or mathematics teacher
using page 3 of this application form. Print this form, complete your part at the top, and have
your teacher complete the rest. Your teacher may forward the completed form directly to Ms
Heather Howard, Academic Assistant, CINSAM at NKU, 519 Founders Hall, Nunn Drive,
Highland Heights, KY 41099, or your may include it with your completed application packet.
3.
CINSAM will not consider your camp application complete until all forms, (1) your
application form as page one, (2) your parent or guardian form as page three, (3) your
teacher recommendation form as page four, and (4) your essay are all on file in the
CINSAM office.
Applicant Check List for Completion of the Required Forms – for the student applicant’s use:
___
I have completed the student application page, page 1.
___
My parent or guardian has completed the parent or guardian page, page 4.
___
I have completed my essay with complete sentences, no miss-spelled words, and meaningful
paragraphs.
___
My teacher has completed the teacher recommendation form page, page 3. (It is included with
the other sheets or your recommending teacher may send this form directly to CINSAM.)
___
I have gotten all of these forms together with needed signatures and mailed them to CINSAM
using this address: Ms Heather Howard, Academic Assistant, CINSAM at NKU, 519
Founders Hall, Nunn Drive, Highland Heights, KY 41099.
___
I have kept a copy of all of these for my and my parent or guardian’s records.
These forms were mailed on _______________________________________________.
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