KAWSE Summer Workshop

Shadow Date

Please select a date to attend

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Student Information

First Name*

Preferred First Name

Last Name*

Email Address*

Mobile Phone Number*

May we text you?

Yes

No

Birthdate*

Please tell us your T-Shirt Size*

Please list a student/group you'd like to room with.*

Mailing Address*

Country

Street

City

Region

Postal Code

School Information

Current/Most Recent School*

High School Graduate Month and Year *

What grade are you in currently?*

Program Details

Please select your top three academic programs of choice

STEM Program of interest 1 *

STEM Program of interest 2 *

STEM Program of interest 3 *

Event Details

Do you have any accessibility needs?*

If other, please explain:

List any dietary restrictions if desired?

Emergency Contact

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact Email Address*

Payment

Please select one of the following regarding your financial need.

Student qualifies for free and reduced-price lunch program. The GROW and EXCITE programs understand that not all people who qualify participate in the program. GROW and EXCITE are only interested in whether the student qualifies for the program.

While the student does not qualify for the free and reduced-price lunch program, she/he/they are just over the threshold to qualify for the program.

Even though the student does not qualify for the free and reduced-price lunch program, she/he/they are experiencing severe financial strain. In the past, people have chosen this option when their house recently burned down, when they are taking care of ill family members, etc.

Student does not qualify for any of above.

Event Payment

Amount Due
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Amount Due

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