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Application Form for the
SUCCEED Workshops

Project SUCCEED: Stimulating Understanding of Computational science through Collaboration, Exploration, Experiment, and Discovery

Use this form to apply for SUCCEED workshops. Once you have submitted this form, we will contact you with more information.

A $25 non-refundable deposit will be due two weeks from receipt of the application. There will also be a one-time only, $25 non-refundable registration fee due with the deposit which are included in the total cost. Both fees will be deducted from the total workshop cost.

You can submit this form online by filling in the appropriate information and clicking on the "Submit" button at the bottom of the page, or you can receive an application by mail by calling (919) 530-1911.

Student's Name:
 Name of Parent/Guardian:
Address:
 City:
State
Zip Code
Daytime Telephone Number
Evening Telephone Number
E-mail
School Name:
Teacher Name (or other academic reference):
School Phone Number:

I would like to apply for :

Fall Workshops:

Saturday Explorations Fall 2008 (rising 6-8th grade):
October 18 - November 22 (from 9 am - 12 pm)

Grade of student during 2008-2009 school year
(if you are a home school student, estimate an approximate grade level):

Type of School:

Age of student (required):

Gender of student (optional):

Ethnicity (optional):

Briefly describe your experiences in science and mathematics (classes, self-study, extracurricular programs, summer activities, etc.). What do you like most about science or mathematics?:

How did you hear about the program? (Required field):

I would like to request a full or partial financial assistance due to financial need. (Please read about the Financial Aid program if you have questions)

Briefly describe why you wish to participate in this program and what you hope to accomplish:

Additional comments or questions:

Once you have submitted your application, a staff member will contact you by email to confirm acceptance into the program.

Last Update:

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