Bridges for SUCCESS
Summer Science Camp@SU
July 5-11, 2015
Henson School of Science & Technology
Salisbury University
1101 Camden Avenue
Salisbury, MD 21801
Application Package
Welcome to the application process for Salisbury University’s Science Camp. The residential camp will be
held on the Salisbury University Campus and is free of charge. Eligible students should be entering 11th or
12th grade in Fall 2015. There are a total of three pages to complete for the application form as well as an
essay and two letters of recommendation. The application form, essay, and letters of recommendation are
due by April 10th, 2015. Several releases, a Health Form, and other documents will be sent to you if you are
selected to participate in the camp; you will be expected to return them to us prior to the start of camp.
Application Process
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Please complete the attached student application form.
A student-written essay must be included with this application. Your essay is to be typed in
a readable font (e.g. Times New Roman and a font size of 12 point). The essay should not
exceed 250 words. In your essay, tell the selection committee why you are interested in
attending the Summer Science Camp@SU at Salisbury University. Include in your essay
what you hope to gain from this experience, your career goals, and how you think it will help
you in the future. If you aren’t sure of a career goal, just tell us about careers that interest
you and why. Be sure to write your name, current grade level and school at the top of your
essay.
Include in the application packet two recommendation forms, one from your science teacher
and one from your mathematics teacher. These forms must be contained in sealed, signed
envelopes.
o Homeschooled Students: Your recommendation forms may be from non-related
adults (i.e. employer, coach, community member, etc.) who can attest to your
academic performance and/or community service. These forms must be contained
in sealed, signed envelopes.
All documents in this application should be returned to:
Dr. Matthew Bailey
Salisbury University
Henson School of Science & Technology
Department of Physics
1101 Camden Avenue
Salisbury, MD 21801
Email: mabailey@salisbury.edu
Please have all application materials in by the deadline date of April 10th, 2015
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If all requested documents are not received by the deadline date, the application will not be
reviewed by the selection committee.
You will receive notification of your application status once the applications have been reviewed. If you have
any questions or need additional information, please contact Dr. Matt Bailey (mabailey@salisbury.edu or
410-543-6486). Please understand that by submitting this application you are not guaranteed acceptance to
the camp. We expect to notify students of their status no later than May 15th, 2015.
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Bridges for SUCCESS
Summer Science Camp@SU
Application Deadline is April 11th, 2014
Please print in blue or black ink or type.
To be completed by Student and Parent/Guardian:
Last Name:
First Name:
Home Street
Address or
Box Number
Middle Initial:
City:
State:
Home Phone:
Parent/Guardian Cell Number:
Student eMail:
Parent/Guardian eMail:
Race/Ethnicity:
(Please indicate)
Caucasian:
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African-American:
Sex:
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Female:□
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Hispanic:
□
Native American:
Current Grade Level
(Academic Yr 10-11):
10th
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11th
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Other
(please specify):
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No:□
Are you a citizen of the United
States?
Date of Birth:
Male:
□
Asian:
Zip Code:
Yes:
T-Shirt Size (adult sizes)
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XS:
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S:
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M:
□
L:
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XL:
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XXL:
Name of School currently attending:
School Address:
School Phone Number:
School District / County:
Name of School student will be attending during
the 2015-2016 academic year:
School Address:
School Phone Number:
School District / County:
Courses Taken in 2014-2015 academic
year:
Courses enrolled in or planning to enroll in
for the 2015-2016 academic year:
Signature of Student:
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Mathematics:
Science:
Mathematics:
Science:
_____________________________________
____________________
(signature)
(date)
Please list the organizations/clubs you belong to and any science/mathematics activities such as
participation in a Science Fair, Science Olympiad, First Robotics, or Math Club, etc. that you have
participated in during the past academic years. Please include awards received and offices that you held
below:
Organizations/Clubs in
Science/Mathematics
Offices Held in Mathematics/Science
Organizations/Clubs
Awards Received in
Mathematics/Science Activities
1.
1.
1.
2.
2.
2.
3.
3.
3.
4.
4.
4.
Please complete the following information below for the custodial parent(s) or guardian(s):
Who does the student
live with?
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Mom:
Dad:
Both:
Other: (Please explain)
__________________________________
Name of Female
Parent or
Guardian:
Mother/Female
Guardian’s
Place of Employment:
Work Phone:
Home Phone:
Cell Phone:
eMail Address:
Signature of Female
Parent or Guardian:
Name of Male
Parent or
Guardian:
Father/Male Guardian’s
Place of Employment:
Work Phone:
_____________________________________
____________________
(signature)
Home Phone:
(date)
Cell Phone:
eMail Address:
Signature of Male
Parent or Guardian:
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_____________________________________
____________________
(signature)
(date)
_____________________________________
____________________
Signature of Student:
(signature)
(date)
Alternate Emergency Contact (This person will be contacted if the parent is not available in an
emergency situation)
Name:
Relationship:
Relative:
Work Phone:
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Neighbor:
□
Friend:
□
Home Phone:
Cell Phone:
Home Address:
Signature of
Parent
or Guardian:
_____________________________________
____________________
(signature)
(date)
How did you hear about Summer Science Camp@SU program?
Counselor:
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Teacher:
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Friend:
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Flyer/Ad:
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School Letter:
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Please have the student camper answer the following questions:
1. I plan to go to college when I finish high school.
Strongly Agree:□ Agree:□ Not Sure:□ Disagree:□ Strongly Disagree:□
2. My parents (guardians) are encouraging me to go to college.
Strongly Agree:□ Agree:□ Not Sure:□ Disagree:□ Strongly Disagree:□
3. My friends plan on going to college.
Strongly Agree:□
4. I enjoy school.
Agree:□ Not Sure:□ Disagree:□ Strongly Disagree:□
Strongly Agree:□ Agree:□ Not Sure:□ Disagree:□ Strongly Disagree:□
5. My teacher(s) care if I go to college.
Strongly Agree:□ Agree:□ Not Sure:□ Disagree:□ Strongly Disagree:□
6. I have a specific career goal(s).
Strongly Agree:□ Agree:□ Not Sure:□ Disagree:□ Strongly Disagree:□
7. I am interested in a career in science and technology.
Strongly Agree:□
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Agree:□ Not Sure:□ Disagree:□ Strongly Disagree:□
Other:
□:____________