Application for all Institutes

Student First Name*
Last Name*
Email*
Gender*
Address 1*
Address 2
City*
State*
Zip Code*
Home Phone Number*
School Name*
What grade are you in?*
Which EAST events are you interested in attending? (Please check all that apply.)*	One-day transition events Summer Camps (week long events) Please check all that you would like to attend. Geocaching Camp, Monday, June 21 - Friday, June 25, 2010 Natural Science Camp, Monday, July 12 – Friday, July 16, 2010 Marine Science Camp, Monday, July 19 – Friday, July 23, 2010 Forensic Science Camp, Monday, July 26 – Friday, July 30, 2010
THE FOLLOWING INFORMATION IS OPTIONAL.
Race/Ethnicity:
Citizenship
GPA
Academic Awards:
Do you have a 504 plan?*
Do you have an IEP?*
Please indicate your condition (check all that apply).	Attention Deficit Hyperactivity Disorder (ADHD) Asperger Syndrome Autism Blindness (visual impairment) Deafness or hearing loss Emotional Disability Mental Retardation Learning Disability Orthopedic Impairment Other Health Impairment Traumatic Brain or Neurological Disability (e.g. spinal cord injury)
Other
We want to know more about you! Please submit to EAST a short presentation which shows us why you should be selected for this no cost opportunity. Please answer these questions:
Why do you want to attend an EAST summer camp?*
What are your educational and career goals?*
What would you like to gain from this experience?*
How will you make the commitment to attend all sessions and continue with other obligations?*
Your short presentation can be done by; personal interview with an EAST staff member, podcast, short video, written essay, collage or piece of artwork, or anything that suits your style. Call or email if you have an additional method and we can talk about it! We are very flexible!