PROMES Engineering Summer Camp Application Camp Date: July 7 - July 12, 2019 We will begin evaluating applications as early as March 1, 2019. Basic Information Full Name * Street Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Postal/Zip Code * Home Phone Number * Cell Number (if applicable) Email * Grade Level as of September 2019 * School Name * If possible, please make my Camp partner List ALL mathematics courses to be completed by June 2019 * List ALL science courses to be completed by June 2019 * Reason/s you are interested in engineering * Reason/s you are interested in attending PROMES Engineering Summer Camp * Citizenship * - Select -US CitizenPermanent Resident Race/Ethnicity (You can choose more than one, data is for statistical purposes only) * American Indian or Alaskan Native Asian or Pacific Islander Black or African American White Hispanic or Latino origin Not of Hispanic or Latino orgin Parent or Legal Guardian Information (to mail CAMP release forms) Full Name * Street Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Postal/Zip Code * Home Phone Number * Work Phone Number Cell Phone Number Email * Submit this form ONLINE With the electronic signature below, I certify that the information I have provided is complete and correct to the best of my knowledge. I authorize the University of Houston PROMES to verify the information I have provided. I further understand that the submission of false information is grounds for rejection of my application. Signature of Applicant * Date * Month MonthApr Day Day20 Year Year2019 CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.
