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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:
City:
State/Province
(US/Canada):
Postal Code:

Required 2.

What is your date of birth? (Please use the format MM/DD/YYYY)


 

50 characters left.
3.

What is the participant's cell phone number?


 

50 characters left.
Required 4.

What is the best way to reach you? 


Cell Phone
Email
Home Phone
Text Messaging
Required 5.

What school do you attend?

 

50 characters left.
Required 6.
In what city or town is your school?
 

50 characters left.
7.
What is the name of your high school advisor?
 

50 characters left.
Required 8.

What grade are you in?

 

7
8
9
10
11
12
Required 9.

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 10.

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 check out the website at http://www.scienceclubforgirls.org/teen-programs.php
 

SUPPER SISTERS: Tuesdays, Cambridge Youth Programs, 6-8pm
MONSTER PROGRAMMING: Wednesdays, MIT, 4:00-6:30pm
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CAMBRIDGE JM PROGRAM: Thursdays, Cambridgeport School, 2:30pm - 5pm
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LAWRENCE JM PROGRAM: Mondays & Wednesdays, South Lawrence East, 3:15 - 5:15pm
LAWRENCE JM PROGRAM: Thursdays, Leonard Middle School, 3:15 - 5:15pm
LAWRENCE MEDIA TEAM: Thursdays, Leonard Middle School, 3:15 5:15pm
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CAMBRIDGE MEDIA TEAM (8th-12th grade only): Wednesdays, Microsoft Store at Prudential Center, Center, 4:00pm-6:30 pm
CAMBRIDGE ROCKET TEAM (8-12th grade only) Tuesdays, Kendall Square, 3:30 - 5:30 pm

Science Club for Girls constantly evaluates the quality of its programming and impact on students. Access to the information requested on this page will allow us to better measure our work and be accountable to our funders. Please help us by filling out this information below. All information is optional, but your participation will greatly help improve our funding and delivery of programs. We report this in aggregate, without identifying information.

 

If you have any questions, please contact the Teen Program Director, Erika O'Bannon at eobannon@scienceclubforgirls.org

 
11.
How long have you been in Science Club for Girls?
First Time
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
12.
What is your ethnic/racial background?
Asian/Asian American
Black (African, African American, Caribbean)
Hispanic/ Latino/ Spanish Origin
Native American
Native Hawaiian/Pacific Islander
Near/Middle Eastern or Arab
White
Two or More Races
Other  
  • Comment:

  • 500 characters left.
13.
Are you eligible for the free/reduced lunch program?
Eligible
Not eligible
14.
What languages are spoken at home? (Check all that apply)
Chinese
Creole
English
French
Japanese
Spanish
Other  
Required 15.

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

 

 

 

350 characters left.
Required 16.

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

 

 

 

350 characters left.
Required 17.

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

 

 

 

350 characters left.