Science Experience Internship

In which term(s) are you interested in participating? (You may select more than one term) *

Summer

Fall

Spring

* Required Fields

Personal Information

First Name: * Enter First Name Middel Name: Last Name: * Enter Last Name	Personal Email: * Please enter email Invalid Email - test@kent.edu Kent Email Address(if known): Invalid Email - test@kent.edu
Home Phone Number: * Invalid Phone Number - 3306720978 Enter Home Phone Number	Cell Phone: Invalid Phone Number - 33066720978
Home Address (Street, City, State, Zip): * Enter Home Address	Date of Birth: * Please enter date of birth

Education

Middle School or High School Name: * Please enter school name	Current Grade Level:
Expected High School Graduation Date: * Please enter expected graduation date	Intended College Major:

Responses

1. List all high school and college science courses you have completed so far, including any you're taking now. Please indicate the grade level in which you have completed such courses, and if any are Honors, Advanced Placement, or College level:

2. What is the last Math Course you have completed? (Please list High School or College course)

3. Have you participated in any extracurricular programs such as Robotics Team, Science Fair, Science Olympiad, Math or Science Club/Camp, Makerspace, or any other Science/Math/Technology-related activies? Please describe.

4. Do you have any relevant hobbies?

5. Anything else we should know about your interests and career goals?

Preferred STEM Area

Below is a list of STEM areas at Kent State. You will need to indicate a desired area of study to assist with placement, which is determined by your research interest and the availability of participating faculty advisors. Which of these areas would you prefer for a Science Experience Internship? Please list up to 5 choices, in order of preference from 1 to 5.

Preference	STEM
1	* Field Required Field Required Invalid Input
2	Field Required Field Required Invalid Input
3	Field Required Field Required Invalid Input
4	Field Required Field Required Invalid Input
5	Field Required Field Required Invalid Input

SIGNATURE: By submitting this form, I understand that placement in the Science Experience Internship is not automatic or guaranteeed and is based upon acceptance into College Credit Plus and faculty member availability. I understand that the timing of placement notifications vary and I will be notified by email once a placment has been made.