Application Deadline: June 30, 2016 $145 for the week all inclusive*
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1 This promises to be a fun filled week with indoor and outdoor hands-on activities. Join us and explore how science, technology, and mathematics are used in engineering design. Engineering Summer Camp 2016 will be open to students entering 8th grade and high school students who will be Freshmen and Sophomores. This day camp will be held July 18-22, 2016 at The University of Texas at Tyler. Application Tuition: Daily Drop-off: Daily Pick-up: $145 for the week all inclusive* 8:00 a.m. 5:00 p.m. Applicants should complete the attached application and mail, fax or scan to The University of Texas at Tyler College of Engineering as soon as possible. Space is limited to 25 applicants. You may register at: uttyler.edu/engineering or by contacting UT Tyler College of Engineering at coe@uttyler.edu or *All inclusive summer camp includes morning and afternoon snacks, lunch, a t-shirt, field trip transportation, field trip admission fees, and all necessary project materials.
2 UT TYLER ENGINEERING SUMMER CAMP Camp Dates: July 18-22, 2016 Application Please complete all information. You must be starting eighth grade or your freshman or sophomore year in high school in August Please indicate any requested exceptions in special circumstances. Application check list: All GENERAL INFORMATION completed and signed by parent PRE-CAMP SURVEY completed ADDITIONAL INFORMATION as needed (not required) signed by parent Tuition: $145.00* Apply early as space is limited to 25 applicants. Application DEADLINE: in office by June 30, 2016 The University of Texas at Tyler 3900 University Blvd. Tyler, TX Phone: Fax: You may mail, fax, or scan and the completed application to: *All inclusive summer camp includes morning and afternoon snacks, lunch, field trip transportation, field trip admission fees, and all necessary project materials.
3 UT Tyler Engineering Summer Camp 2016 Application Personal Information and Parent/Guardian Consent NOTE: All sections and information must be completed and in office by: June 30, Please fill-in every space even if information is requested more than once. All information will be kept in strict confidence and used only in a manner consistent with the regulations of The University of Texas at Tyler. Please print neatly or type this information. STUDENT INFORMATION Full Name: Date: Birth Date: Adult T-Shirt Size: Gender: Female Male Social Security number will be requested on a separate form during the first day of camp for research by THECB on program effectiveness since the camp is supported by a grant. Primary Language: Spanish English Other: Race/Ethnicity: Hispanic African-America Asian/Pacific Islander American Indian/Alaskan Native White Other Mailing Address: City: State: Zip: Phone: School: City: What special physical or dietary accommodations do you require, if any? Please describe: PARENT/GUARDIAN INFORMATION Name: Relation to student: Home Address (if different from student above): City: Phone: Work Phone: State: Zip: Cell Phone: Parent/Guardian Consent: I certify that I am the parent or legal guardian of this student and agree to allow her/him to fully participate in The UT Tyler Engineering Camp 2016 including all travel necessary to attend all academy field trips. I also agree to be a participant in The UT Tyler Engineering Camp 2016 by encouraging my child s participation in the program and taking necessary steps to ensure her/his success. I will sign all necessary medical releases and provide insurance information as needed. Parent Signature: Date:
4 UT Tyler Engineering Camp 2016 Answers to this pre-test will not be reviewed as part of the selection criteria. THECB requires completion of pre and post-tests to evaluate program effectiveness since the camp is supported by a grant. Pre-Camp Survey
5 UT Tyler Engineering Camp 2016 Application Additional Information Student: School: Please let us know about any accessibility needs you may have or anything else you would like for us to know about you prior to your arrival. Please also indicate any special circumstances that would require a full or partial scholarship for you to attend for economic reasons.
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