Application for 2016 High School Marine Science Summer Lab Experience Program Dates: July 7-13, 2016 Sponsored by USC Sea Grant, USC Wrigley Marine Science Center, CDEBI All applicants must: 1) Complete the registration form below. 2) Attach a student written essay (maximum 2 pages) or video of yourself (maximum 5 minutes) addressing: a. Why you would like to participate; b. Why you would like to be selected for this program; and c. How you will share what you learned from this program after it is over. 3) Include a letter of recommendation from a teacher. 4) Attach a photo of yourself. Application deadline: 5 PM on March 25, 2016 Participant Information Name:__________________________________________________________________________ Date of Birth: __________________________________________________________________ Street Address: ________________________________________________________________ City: _____________________________________ State: __________ Zip: _____________ Home Phone: ___________________________________________________________________ Email: ___________________________________________________________________________

Application 2016 High School Summer Marine Lab...Application for 2016 High School Marine Science Summer Lab Experience Program Dates: July 7-13, 2016 Sponsored by USC Sea Grant, USC

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Applicationfor2016HighSchoolMarineScienceSummerLabExperience

ProgramDates:July7-13,2016

SponsoredbyUSCSeaGrant,USCWrigleyMarineScienceCenter,CDEBIAllapplicantsmust:1) Completetheregistrationformbelow.2) Attachastudentwrittenessay(maximum2pages)orvideoofyourself(maximum5minutes)addressing:a. Whyyouwouldliketoparticipate;b. Whyyouwouldliketobeselectedforthisprogram;andc. Howyouwillsharewhatyoulearnedfromthisprogramafteritisover.

3) Includealetterofrecommendationfromateacher.4) Attachaphotoofyourself.

Applicationdeadline:5PMonMarch25,2016ParticipantInformationName:__________________________________________________________________________

DateofBirth:__________________________________________________________________

StreetAddress:________________________________________________________________

City:_____________________________________State:__________Zip:_____________

HomePhone:___________________________________________________________________

Email:___________________________________________________________________________

Gradelevelinfall2016:_________________

School:____________________________________________________________

Previouscamporsummerprogramexperience:

___________________________________________________________________________________

DemographicInformationGender:________________________________

USCitizenorgreencard:YES_________NO___________

Disability:YES____________NO_______________

Ifyes,pleasespecifyanyaccommodationsthatwillhelpyoubemoresuccessfulintheprogram:__________________________________________________________________________________

EthnicIdentity:

________AlaskanNativeorAmericanIndian________BlackorAfricanAmerican________Hispanic/Latino________NativeHawaiianorotherPacificIslander________Multiracial________WhiteorCaucasion________Other:_______________________________________________Declinetoanswer

Page 3: Application 2016 High School Summer Marine Lab...Application for 2016 High School Marine Science Summer Lab Experience Program Dates: July 7-13, 2016 Sponsored by USC Sea Grant, USC

Wheredidyouhearaboutthisprogram?___________________________________Parent/GuardianInformationName: ______________________________________ Relationshiptoparticipant: ______________________________________

StreetAddress:

City: State: Zip:

Homephone: email:

Signature: _____________________________

PleaseemailapplicationandmaterialsbyMarch25,2016to:[email protected]

Orsendbypostto:USCSeaGrant3454TrousdalePkwy,CAS200LosAngeles,CA90089-0373Thankyouforyourinterestinthisprogram!