PRISM 2025 Science Club Application

Program requirements: Complete application. Current high school student residing in Boston, Cambridge or Massachusetts Gateway city, or attending a Title I school. Expressed interest in STEM school work and future path. Reference provided by school personnel or STEM program staff. Able to attend all sessions. Able to commute to Kendall Square. Must be fully vaccinated against COVID-19 and influenza, and able to provide proof thereof. Deadline for application is February 10, 2025.

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* 1. First name

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* 2. Last Name

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* 3. Preferred pronouns

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* 4. Birthdate

Date

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* 5. Preferred email address

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* 6. Telephone number

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* 7. Current address: Street name and number

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* 8. Current address: Apartment number (write NA if none)

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* 9. Current address: City or town, state, zip code

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* 10. Gender

Male

Female

Non-binary

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* 11. Race/ethnicity (select all that apply)

Indigenous North American (American Indian or Alaska Native)

Asian or South Asian

Black or African American

Native Hawaiian or Pacific Islander

White, non-Hispanic

Latinx/Hispanic

Arabic, Middle Eastern or North African

Prefer not to say

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* 12. Are you or your family currently eligible for any of the following programs?

Supplemental Nutrition Assistance Program (SNAP)

Transitional Aid to Families with Dependent Children (TAFDC)

DCF Foster Care Programs

MassHealth or Medicaid

Public or Subsidized Housing Assistance

Other (please specify)

None of the above

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* 13. What is the highest level of education completed by any parent or caregiver who lives with you?

Less than a high school diploma

High school graduate or GED completed

Some college, Associate degrees (AA, AS), or vocational degree

Bachelor's degree (BA, BS, AB) or more

Don't know

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* 14. School name

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* 15. School city

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* 16. Current grade you are in

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* 17. Science classes taken (or taking now)

Biology

AP Biology

Chemistry

AP Chemistry

Biotechnology

Anatomy and Physiology

Physics

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* 18. Current GPA

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* 19. Statement of interest: please write a short paragraph about why you are interested in attending the PRISM Science Club. Please include how it relates to your current interests, school work, and future goals.

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* 20. If selected, do you expect to be able to attend ALL sessions?

Yes

Maybe

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* 21. Please list any other after-school or summer STEM programs you have or are participating in. Be sure to include the name of the program.

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* 22. Please list any current or former family responsibilities (e.g. watching siblings, caring for family member) and work/job commitments you may have.

PRISM 2025 Science Club Application

Question Title

* 1. First name

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* 2. Last Name

Question Title

* 3. Preferred pronouns

Question Title

* 4. Birthdate

Question Title

* 5. Preferred email address

Question Title

* 6. Telephone number

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* 7. Current address: Street name and number

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* 8. Current address: Apartment number (write NA if none)

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* 9. Current address: City or town, state, zip code

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* 10. Gender

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* 11. Race/ethnicity (select all that apply)

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* 12. Are you or your family currently eligible for any of the following programs?

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* 13. What is the highest level of education completed by any parent or caregiver who lives with you?

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* 14. School name

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* 15. School city

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* 16. Current grade you are in

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* 17. Science classes taken (or taking now)

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* 18. Current GPA

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* 19. Statement of interest: please write a short paragraph about why you are interested in attending the PRISM Science Club. Please include how it relates to your current interests, school work, and future goals.

Question Title

* 20. If selected, do you expect to be able to attend ALL sessions?

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* 21. Please list any other after-school or summer STEM programs you have or are participating in. Be sure to include the name of the program.

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* 22. Please list any current or former family responsibilities (e.g. watching siblings, caring for family member) and work/job commitments you may have.

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* 23. Reference name for us to contact

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* 24. Reference primary role

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* 25. Reference email address (VERY IMPORTANT TO MAKE SURE THIS IS ACCURATE!)

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* 26. Reference phone number