Student Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone Number *

Country

(###)

###

####

Have you taken any AP classes? *

Yes

No

Do you have any prior commitments during the program dates? If yes, please specify how you will balance them.

Yes

No

In the event that you're not placed in a group project, would you be open to doing an independent research project with a mentor? *

Yes

No

Do you have any specific needs or accommodations we should be aware of to better support your participation? *

Yes

No

Please acknowledge the following program requirements: *

I can attend work sessions (3-5 hours per week virtually) between july 14th to August 22nd.

I have reviewed the program description & brochure, the terms & conditions on the website, and can pay the program fee by July 11th.