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: ____________________ 1 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 2 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 _______________________________________________. 3