This program is now looking for interested female high school students entering 10th, 11th or 12th grade.

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1 Engineering Teens. Engineering Summer Camp 2010 Interested? Apply now! June This program is now looking for interested female high school students entering 10th, 11th or 12th grade. The Engineering Summer Camp 2010 focuses on career awareness, introduction to lab work and research, understanding what it means to work in the science and math fields, and on group- and problem-based learning. Class lectures will include engineering design, mathematics, physics and computer applications. These will be followed by design and hands-on project-building sessions. The program offers field trips, which will demonstrate local engineering projects and career possibilities. The program is a weeklong day camp, from June 14-18, 9 a.m. to 4 p.m. Lunch will be provided, and a scholarship of $100 will be paid to each student attending the whole week. What are you waiting for? Submit your completed application to the address found at the end of the application. Office of Applied Technologies and Applied Engineering ITECC Suite C-300, 301 Mexico Boulevard Brownsville, TX Phone (956) Fax (956)

2 Engineering Summer Camp 2010 Student Application Form June 14-18, 2010 Office of Applied Technologies Date: Student s Name: Date of Birth: / / SSN mm / dd / yyyy (confidential, used only for research on program effectiveness) Student s ID Number: Circle appropriate answer Gender: Male Female Race/Ethnicity: Hispanic African American American Indian/Alaskan Native Caucasian Asian/Pacific Islander Other (please specify): Primary language spoken at home: English Spanish Other (please specify): How did you hear about the Engineering Summer Camp 2010? Counselor Teacher Flyer or other advertisement Letter from your high school or district Letter from a college or university Other (please specify): Educational Attainment of Parents/Guardians (circle the highest level completed) Mother/ Female Guardian No Some High School Graduate Some College Bachelor s Degree or Higher Don t Know/ Not Applicable Father/ Male Guardian No Some High School Graduate Some College Bachelor s Degree or Higher Don t Know/ Not Applicable

3 List the following Extracurricular activities in high school (example: sports, choir, school newspaper): Awards and honors (example: placing in academic competition, honor roll, etc.): Community service activities (example: volunteering with homeless, tutoring younger students, etc.): Check the best answer Strongly Agree Agree Not Sure/ Neutral Disagree Strongly Disagree I plan to go to college when I finish high school. My parents or guardians are encouraging me to go to college. My friends plan on going to college. I enjoy school. My teachers or counselors care if I go to college. I am interested in specific colleges. Please specify: I have a specific career goals. I am interested in a career in engineering. Did you or any member of your family qualify for the free or reduced lunch program during the school year? (circle only one answer) Yes No Not Applicable Don t Want to Answer Grade level, spring 2010: Other (please specify): Which high school plan do you expect to graduate under? (circle only one answer) Minimum Recommended Distinguished Don t Know Other (please specify): Name of School (Spring 2010): City: School District:

4 Engineering Summer Camp 2010 Student Consent Form Date: Student s Name: Date of Birth: / / mm / dd / yyyy SSN (confidential, used only for research on program effectiveness) Address: Phone Number: ID Number: (confidential, used only for research on program effectiveness) Parent s or Guardian s Name: and the Texas Higher Education Coordinating Board are using student data to evaluate the effectiveness of this program. All data is confidential. It will be reported only in the aggregate and for the express purpose of measuring and reporting on the effectiveness of this program. I understand that any such information will be used by and the Texas Higher Education Coordinating Board only for these purposes, that The University of Texas at Brownsville and Texas Southmost College and the Texas Higher Education Coordinating Board will not disclose any such information that personally identifies a student to any other party, and that any report generated on the basis of this information will not personally identify any student. Student Signature parent or Legal Guardian (Required, if student is 18 years of age or younger) Please return completed application packet to: Alejandra Resendez UTB/TSC Office of Applied Technologies ITECC, Suite C-300, 301 Mexico Boulevard, Brownsville, TX Phone (956) Fax (956)

5 Campamento de verano de ingeniería 2010 Formulario de Consentimiento del Estudiante Fecha: Nombre del estudiante: Fecha de nacimiento: / / mes / día / año SSN (confidencial, usado sólo para investigación de la efectividad del programa) Domicilio: Número de teléfono: Número de identificación de preparatoria del estudiante: (si está disponible) Nombre del padre, madre o tutor: La Universidad de Texas en Brownsville y el Colegio del Extremo Sur de Texas y la Junta Coordinadora para la Educación Superior en Texas usarán los datos de los estudiantes para evaluar la efectividad de este programa. Todos los datos son confidenciales. Sólo serán informados de manera agregada y con la finalidad expresa de medir e informar la efectividad de este programa. Yo comprendo que dicha información será usada por La Universidad de Texas en Brownsville y el Colegio del Extremo Sur de Texas y la Junta Coordinadora para la Educación Superior en Texas solamente para estos fines, que La Universidad de Texas en Brownsville y el Colegio del Extremo Sur de Texas y la Junta Coordinadora para la Educación Superior en Texas no darán a conocer a ninguna otra parte, ninguna información que identifique personalmente a un estudiante, y que cualquier informe generado en base a esta información no identificará personalmente a ningún estudiante. Firma del estudiante padre, madre o tutor (necesario si el estudiante tiene 18 años o menos) Favor de entregrar la solicitud a: Alejandra Resendez UTB/TSC Office of Applied Technologies ITECC, Suite C-300, 301 Mexico Boulevard, Brownsville, TX Phone (956) Fax (956)

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