Science Experience Internship

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

SummerFallSpring .

* Required Fields

Personal Information

First Name: * Middel Name: Last Name: *	Personal Email: * Kent Email Address(if known):
Home Phone Number: *	Cell Phone:
Home Address (Street, City, State, Zip): *	Date of Birth: *

Education

Middle School or High School Name: *	Current Grade Level:
Expected High School 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	*
2
3
4
5

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.