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Science Club for Girls Teen Application 2012
RequiredRequired Question(s)
Progress: 
 
Required 1.

Please enter the participant's information indicated below.


First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 2.

What is your date of birth?

 

50 characters left.
3.

What is the particpant's cell phone number?

 

 

50 characters left.
Required 4.

What is the best way to reach you?

Home Phone
Cell Phone
Text Messaging
Email
Required 5.

What school do you attend?

 

50 characters left.
Required 6.

What grade are you in?

 

7
8
9
10
11
12
Required 7.

Are there any medical issues or conditions that you would like us to know about?  (Allergies to foods, latex, medicines, bee sting, etc.)

If yes, please explain.

 

Yes
No
  • Comment:

  • 500 characters left.
Required 8.

Please check the site where you would like to work .

If you are not sure about which program location is the best fit for you, please call us at 617-391-0361, extension 3. Keep in mind that most teens will choose to work at a site that is nearest to their home.

 

 

 

BOSTON: Site is FULL
BOSTON: Site is FULL
BOSTON: Site is FULL
CAMBRIDGE: Tuesdays, King Open School, 3pm-5:30pm
CAMBRIDGE: Wednesdays, Fletcher Maynard Academy, 2pm-4:30pm
CAMBRIDGE: Thursdays, Cambridgeport School, 2:30pm-5pm
CAMBRIDGE: Fridays, Amigos School, 3pm-5:30pm
LAWRENCE (11th-12th grade only): Mondays, Leonard School, 3pm-5pm
LAWRENCE (11th-12th grade only): Thursdays, Esperanza Academy, 3:45-5:45pm
LAWRENCE MEDIA TEAM (8th-10th grade only): Mondays, Leonard School, 3:30pm-5om
NEWTON (8th-12th grade only): Saturdays, Myrtle Baptist Church, 2:30-4pm
CAMBRIDGE SUPPER SISTERS (9th-12th grade only): Thursdays, Russell Youth Center, 5:30pm-8:30pm
CAMBRIDGE MEDIA TEAM (9th-12th grade only): Wednesdays, Microsoft NERD Center, 3:30pm-6pm
Required 9.

Are you involved in any other activities after school? Include the days and times of this activity.

 

 

 

350 characters left.
Required 10.

Why do you want to join the sisterhood of Science Club for Girls?

 

 

 

350 characters left.
Required 11.

Tell us about a time that you have showed one of the SCFG traits: strength, commitment, friendship, growth.

 

 

 

350 characters left.