ECU's Explorations in Computer Science and Robotics

2013 APPLICATION FORM

Explorations in Computer Science & Robotics
One-Week Residential Summer Academy

Sunday, June 16^th through Friday, June 21^st on ECU Campus in Ada, Oklahoma

STUDENT INFORMATION

First Name: Middle Name: Last Name:

Date of Birth (mm/dd/yyyy): //

Grade you will be entering in Fall 2013:

Gender:

CONTACT INFORMATION

Home Mailing Address:

Street or Box Number:

City State: Oklahoma Zip Code: County:

Email:

Phone: () -

SCHOOL INFORMATION

Name of School:

Location of School (City/Town):

Type of School:

ADDITIONAL REQUIRED INFORMATION

Ethnicity (Select all that apply)

American Indian/Alaska Native	Native Hawaiian/Other Pacific Islander
Asian	Hispanic American
Black/African American	White
Prefer not to respond or none of these apply (any other responses will be ignored)

Have any of your parents or grandparents completed a college degree? Yes No

Why do you want to participate in this summer academy?

Why do you believe you should be selected?

APPLICATION/SELECTION PROCESS

You should only submit one application. Multiple submissions will be ignored with the most recent being considered the official application.
Make sure all information is complete and accurate. Incomplete applications may not be considered. Providing inaccurate information may result in disqualification.
Review of Applications will begin on April 1st and will continue through June 1^st or until all positions are filled with eligible applicants.
Selected applicants will be notified via Email/Mail and must accept/decline their invitation by the deadline specified in that notification or they will forfeit their opportunity to participate.
Once all positions have been filled, all remaining applicants will be notified. If interested, they may be placed on a waitlist at that time in case we have a cancellation.

If selected, what size t-shirt do you wear:

By selecting "Submit" below, you will be applying for the opportunity to participate in ECU's Explorations in Computer Science and Robotics Summer Academy and acknowledge that all information provided in this application may be used during the selection and/or reporting process.