HAMPTON UNIVERSITY
HAMPTON, VIRGINIA 23668
INSTRUCTIONS
· Tuition (full scholarship)
· Important Dates
o PROGRAM SCHEDULE: July 13 – July 19th, 2014
o NOTIFICATION : Continuous until program is full
· Complete applicaion as soon as possible
· Submit the following items
o Completed Application Form
o Letter of Recommendation
o Completed Participation Health Form
o Mail Application package to:
Applications should be filled out electronically, scanned and sent to your TAI regional President:
Central Region..........Marv Abrams:
Eastern Region.........Quincy Magwood:
Western Region........Larry Jackson:
HAMPTON INSTITUTE ∙ GRADUATE COLLEGE ∙ COLLEGE OF
THE UNDERGRADUATE COLLEGE CONTINUING EDUCATION
HAMPTON UNIVERSITY
HAMPTON, VIRGINIA 23668
TAI/HU STEM ACADEMY
PROGRAM APPLICATION
APPLICANT INFORMATION
Name: __________________________________________ Date of Birth: _____/________/______
Street Address: _______________________________________ Unit/Apt #: _____________
City: _______________________ State: ________________ Zip Code: ______________
Home Phone: (______) ______________ Cell Phone: (______) ______________
Email: _________________________________________________________________________
Gender (Circle One): Male Female Are you a US Citizen or Permanent Resident? Yes No
T Shirt Size (circle One): Child: S M L XL Adult: S M L XL XXL
Current High School: ____________________________________________ CUM GPA: _____/_____
Address: _____________________________________________________________________________
Parent/Guardian Information
Name(s): ______________________________________________ Relation: _____________________
Street Address: _____________________________________ Unit/Apt #: __________
City: _______________________ State: ________________ Zip Code: __________
Home Phone: (______) ______________ Cell Phone: (______) ______________
Email: _________________________________________________________________________
In Case of Emergency, in addition to person(s) listed above, contact:
Name(s): ______________________________________________ Relation: _____________________
Address:________________________________________________ Phone: (______) ______________
Email: _________________________________________________________________________
Student Applicant Essay Questions
(Student Applicant: Please type or print neatly – you may use a separate page, no more than two pages)
I am interested in the “TAI-HU Summer STEM Academy Program” because:
(Please write a brief essay telling us about your interests in STEM and aviation)
Tell us about your interests and how you spend your spare time?
Tell us about yourself as a student. What is your favorite subject? What are you most successful with? What is an area of school or academic need that a mentor can help you with?
Tell us about someone in your life you consider a mentor and why they are special to you?
How would being part of the “TAI-HU Summer STEM Academy Program” impact your future?
Parent/Guardian Questions:
Has your child had any behavioral problems in school or the community (such as fighting, shop-lifting, destruction of property, bullying or fire setting)? ___ Yes ___ No
If yes what was the problem?
Has your child ever been arrested? ___ Yes ___ No
Has your child been suspended from school? ___ Yes ___ No
HAMPTON INSTITUTE GRADUATE COLLEGE ∙ COLLEGE OF
THE UNDERGRADUATE COLLEGE CONTINUING EDUCATION
HAMPTON UNIVERSITY
HAMPTON, VIRGINIA 23668
__________________________
Applicant Signature
______________________________
Parent/Guardian Signature (required)
HAMPTON INSTITUTE GRADUATE COLLEGE ∙ COLLEGE OF
THE UNDERGRADUATE COLLEGE CONTINUING EDUCATION
HAMPTON UNIVERSITY
HAMPTON, VIRGINIA 23668
________________________ ____________________________
DATE DATE
HAMPTON INSTITUTE GRADUATE COLLEGE ∙ COLLEGE OF
THE UNDERGRADUATE COLLEGE CONTINUING EDUCATION
HAMPTON UNIVERSITY
HAMPTON, VIRGINIA 23668
TAI/HU STEM Academy Informed Consent Form
Dear Parent(s) or Guardian(s)
While your son/daughter is participating in the TAI/HU STEM Academy and is involved in educational activities sponsored by the program, part of the activities will involve field trips and photographs may be taken of participants by HU and TAI. Also, HU and TAI may collect additional information related to your child’s interest in STEM and aviation careers, information that will help improve the program for future participants. This is a residential program where your son/daughter is responsible for maintaining proper conduct during the program, and dangerous or illegal activity may result in your son/daughter being sent home early. For these reasons, the program needs your consent to approve these activities.
All costs incurred in field trips will be covered by the Program.
Sincerely,
TAI/HU STEM Academy Staff
PLEASE FILL IN THE FORM BELOW (a signed copy will be available for your records):
I, ___________________________, give my consent for ___________________________ to Parent(s)/Guardian(s) Student
participate in the TAI/HU STEM Academy activities.
Signature ___________________________________________ Date ______________________ Parent(s)/Guardian(s)
Signature ___________________________________________ Date ______________________ Program Director
TAI/HU STEM ACADEMY
Reference Form
Thank you for providing a recommendation for _________________________________________ to participate in the Tuskegee Airmen, Inc./ Hampton University STEM Academy at Hampton University, a unique one-week residential program for high school students that introduces STEM through aviation.
To complete your recommendation, please fill out the form below. After completing this form, please place it in an envelope (not provided). Seal the envelope and sign it across the seal. You may remit this recommendation to the above named student or mail it directly to. Dr. Eric J. Sheppard, TAI/HU STEM Academy, School of Engineering & Technology, Hampton University, Hampton, VA 23668.
Please type or print neatly.
FIRST NAME: LAST NAME:
ADDRESS:
CITY: STATE: ZIP:
CONTACT PHONE NUMBER: EMAIL ADDRESS:
What is your relationship to the candidate?
Please tell us why this candidate should be selected for participation in the TAI/HU STEM Academy Program at Hampton University (use additional pages if necessary).
HAMPTON INSTITUTE ∙ GRADUATE COLLEGE ∙ COLLEGE OF
THE UNDERGRADUATE COLLEGE CONTINUING EDUCATION