2015 Biosphere 2 Science Academy Application Form Question Title * 1. Student Applicant Information Last Name: First Name: Age: Date of Birth: Gender: Nickname (or what student prefers to be called): SCHOOL NAME, City and State (Spring 2015): SCHOOL NAME, City and State (Fall 2015): Grade in Fall 2015: Home Address: City: State: Zipcode: Home phone: Email Address: Question Title * 2. Did you attend the 2014 Biosphere 2 Science Academy program? Yes, the middle school week, June 6 - 12, 2014 Yes, the high school week, June 13 - 19, 2014 No, I did not attend last year Question Title * 3. PARENT / GUARDIAN INFORMATION Parent/Guardian 1: Last Name First Name: Primary Phone Number: Secondary Phone Number: Email Address: Parent/Guardian 2: Last Name First Name: Primary Phone Number: Secondary Phone Number: Email Address: Question Title * 4. BIOSPHERE 2 SCIENCE ACADEMY WEEK SELECTION (check one) July 12-18, 2015 (for rising 7-9th grade students) July 19-25, 2015 (for rising 9-12th grade students) Question Title * 5. DEPOSIT INFORMATIONIf your student is selected to participate in the 2015 Science Academy, a non-refundable deposit of $250.00 will be required along with the completion of a registration packet.Payment information:Credit Card: Contact Nancy Boklund at (520) 838-6192Checks: payable to U of A, Biosphere 2 (please write student's name and "Science Academy" on memo line). Mail To: Biosphere 2 Science Academy, Attn: Nancy Boklund, P.O. Box 8746 Tucson, AZ 85738 I acknowledge that a non-refundable deposit of $250.00 will be required should my student be selected. Question Title * 6. UPON ARRIVAL, STUDENTS WILL RECEIVEa Biosphere 2 t-shirt, hat, water bottle, and notebook.Please indicate the shirt size needed (in men's sizes). Small Medium Large X-Large 2X-Large Other Size (please specify) Question Title * 7. DROP-OFF and PICK-UP AUTHORIZATIONPlease only provide names of those, other than parents/guardians listed above, who are authorized to pick up your student. IDENTIFICATION WILL BE REQUIRED. Authorized Person 1: (first and last name, phone number) Authorized Person 2: (first and last name, phone number) Question Title * 8. CHECK-IN and CHECK-OUT:Sunday Student Check-in: Noon - 3PMSaturday Student Symposium: 10AM, FAMILIES ARE WELCOME!Saturday Student Check-out: Noon - 2PM Please indicate if you would like Biosphere 2 to provide student transportation TO and/or FROM the Tucson International Airport ($50 each way per student). We will follow up regarding details. No, thank you, we will not need transportation TO and/or FROM the Tucson International Airport Question Title * 9. Essay question: Please describe briefly your expectations of the Biosphere 2 Science Academy, what you hope to gain from the experience, and why you should be selected. (350 words or less) Question Title * 10. Teacher Recommendation: Please ask a current or recent teacher to provide a recommendation for the applying student. The recommendation should be sent via email to Nancy Boklund at <nboklund@email.arizona.edu>.The recommendation should include, but not be limited to, the following information:*In the email subject line, please type: "Teacher Recommendation for (name of applying student), 2015 Biosphere 2 Science Academy"*Why the student would be a good candidate to attend the week-long 2015 Biosphere 2 Science Academy (e.g. academic capabilities, interest in science, social skills, maturity, etc.)*Teacher contact information I have asked, or will ask, a teacher to submit a recommendation on my behalf. Question Title * 11. Contact information for recommending teacher Teacher's Name: Teacher's email address: Teacher's phone number: Question Title * 12. How did you hear about the Biosphere 2 Science Academy? Biosphere 2 Website Social Media School or Teacher Biosphere 2 Visit Print Media Other (please specify) Question Title * 13. ADDITIONAL INFORMATION THAT YOU MAY WANT TO SHARE: For additional details about the 2015 Biosphere 2 Science Academy, including sample schedules, faculty biographies, and pricing information, please see: http://b2science.org/outreach/sciacademy Your voluntary submission of this form electronically serves as your signature in place of a traditionally signed form. By registering, submitting payment, and completing the required forms online you are authorizing that the information is correct and you are in agreement with the terms and conditions of this Program. Done