2018 Summer STEM Camp Registration Question Title * 1. Name of Student (First and Last) OK Question Title * 2. Student's e-mail address (or parent's email if student does not have one) OK Question Title * 3. Best Contact Phone Number for Student OK Question Title * 4. Parent’s Name OK Question Title * 5. Best Contact Phone Number for Parent OK Question Title * 6. Parent's Email Address OK Question Title * 7. Choose your age 14 15 16 17 18 OK Question Title * 8. Please write the name of your middle school or high school OK Question Title * 9. Do you have a disability? Yes No OK Question Title * 10. Are you currently on an Individualized Education Program (IEP) or a 504 Plan at your school? Yes No OK Question Title * 11. Do you have a VR Counselor? Yes No OK Question Title * 12. If yes, what is his/her name? OK Question Title * 13. What is your primary disability? If you have more than one, please list the primary followed by the others. OK Question Title * 14. Do you require any learning accommodations or accessible materials? Yes No OK Question Title * 15. If other, please specify: OK Question Title * 16. What are your top 3 career choices? OK Question Title * 17. What do you hope to get out of this week? OK Question Title * 18. T-Shirt Size: Small Medium Large X-Large XX-Large XXX-Large XXXX-Large OK Question Title * 19. Do you have any food allergies? If so, please describe those allergies. OK Question Title * 20. What, if any, special dietary needs do you have? OK DONE