Student Membership Application

STUDENT MEMBERSHIP APPLICATION

SECTION A – Student Information
First	Middle	Last		Age
Current Date: / /	Student’s birth date / /		Male {_} Female {_}
School	Grade		Race/Ethnicity

PARENTS OR GUARDIANS (TO WHOM CORRESPONDENCE WILL BE SENT)

First name Last name
Relationship to Student
Address
City	State	Zip Code
Home Phone # Parent’s contact #
E-mail Address
Employer’s Name (Optional)
Emergency contact name __________________________________________ Emergency Phone # _____________________________________________

SECTION B - JETS (Junior Engineers Tomorrow’s Scientists) Program

Please rank which JETS class you are interested in attending, with number one (1) being your first choice. You may be placed in a different class than your first choice if that class if filled or you do not meet the course pre-requisites

___ Architecture ___ BASIC Programming ___ C Programming

___ Civil Engineering ___ Electronics ___ Introduction to Internet

___ Mechanical Engineering

Have you attended the JETS program before? _Yes _No How many years ____________

List all JETS classes you have previously attended.

Do you participate in ROTC or have an interest in attending a Service Academy? _ Yes _ No

Do you participate in sports or other extra curricular activities? ______Yes ______ No

If yes, please list all other activities you participate in. _ _________________

How did you find out about CABPES?

____________

SECTION C - MEP (Math Enrichment Program)

Indicate the course(s) in which you will need assistance. You may choose more than one.

______ Algebra _____ Chemistry ______ Calculus ______ Physics

______ Pre-Algebra _____ Trigonometry ______ Probability & Statistics

______ Geometry ______ Science or Other Please Specify __________________________

List the name of the Math/Science book(s) or workbook you currently use at school.

_________________________________________________________________________________

Are you allowed to bring your Math/Science textbook home? _____ Yes _____ No

Math/Science teacher or counselor’s name: ______________________________________

What is your current grade in Math/Science? ___ A ___ B ___ C ___ D ___ F

Have you attended the CABPES’ (MEP) Math Enrichment Program before? __ Yes __ No

Year(s) attended. _________

Are you currently participating in another tutoring program? _____ Yes ____ No

If yes, please list name and day(s) you participate in the program

_________________________________________________________________________________

SECTION–D SAT (Scholastic Aptitude Test) Preparation Program

Please select which SAT session you are interested in attending.

______ Fall Session _____ Spring Session

(Classes begin September 29, 2004) (Classes begin February 16, 2005)

Have you previously taken the SAT or ACT test? ____ Yes ____ No

If yes, please provide your test scores __________________________________

What is your career interest? ____________________________________________________________

______________________________________________________________________________________

Have you made plans to attend college? _____ Yes _____ No

List three potential colleges you are interested in attending

1) _______________________________ 2) ________________________ 3) _________________________

Notes: Please notify CABPES of any address or telephone number changes.es.

Office Use

DATE \@ "M/d/yyyy h:mm am/pm" 7/29/2006 6:07 PM

Application Forms

Welcome to the CABPES Registration Section. All the forms that you need to register for CABPES programs are in this section. To register, you must print the forms, complete them and mail them with the appropriate fees.

Scholarships

Proceeds from the Annual Awards Banquet provide scholarship funds for graduating seniors who are pursuing college studies in engineering or science.