Your Future in Energy A One Week Program for High School Students Section 1: June 25, 2012 June 29, 2012 Section 2: July 23, 2012 July 27, 2012 Westchester Community College and Entergy are pleased to be partnering with local high schools in Westchester County on an innovative program designed to introduce high school students entering the 11th and 12th grades to the field of energy. This program will expose students to professionals from the industry and will allow them to spend a week in a college setting while learning about the different areas of the energy industry. Highlights of the program: An opportunity to learn about the fundamentals of energy science. Except for a $15 registration fee, the program is fully subsidized. Field trips to Indian Point Nuclear Power Plant and Con Edison. Exposure to professionals from the energy community. To register for this program, please see the form on the other side of this flyer. Seats are limited and students will be accommodated on a first-come, firstserved basis.
APPLICATION FORM Deadline: Month Day Year $15 Registration Fee is due with application (non-refundable unless you are not accepted into the program). Camper Information Name: Preferred First Name for Nametag: Home Address: Street City State Zip Birth Date: Age: Gender: Male Female T-shirt size: x-small small med large x-large xx-large Phone (daytime number to call if we have questions): Email: Name of high school: Year you will graduate: Session (circle 1): Section 1: June 25, 2012 June 29, 2012 Section 2: July 23, 2012 July 27, 2012 Parent Information Parent/Guardian s Name: Parent/Guardian s Home Phone: Work Phone: Emergency Contact Number: Cell Phone: email: Payment Please check one of the following: A check in the amount of $15 is enclosed (made payable to Westchester Community College). Please charge deposit to the following credit card: VISA MasterCard Discover Name of Card Holder: Card Number: CVV number: (3 digit code on back of card) Expiration Date: / Amount: $ Authorized Signature: Card Holder Billing Address (if different from above): City, State Zip Code Card Holder Phone: Please mail this signed form along with a non-refundable $15 registration fee to: The Professional Development Center Westchester Community College 75 Grasslands Road
Energy Camp Permission Slip I understand that for the Westchester Community College Summer Energy program to be held between (Circle One) Section 1: June 25, 2012 June 29, 2012 Section 2: July 23, 2012 July 27, 2012 may have the opportunity to attend program related (Print Child s Full Name) off-campus trips. I understand that faculty members and agents of Westchester Community College will supervise all trips and that my child will be transported in a college-owned or contracted vehicle. I request that my child be allowed to attend all such field trips that s/he is eligible to attend. I further understand that my child will be required to submit his/her social security number or passport or green card for the trip as part of the application process and that failure to do so may result in his/her inability to attend the off campus trips. I understand that should I not want my child to attend a specific off campus, school related trip, it is my responsibility to notify Steve Leone, Professional Development Center at 914-606-6658, within 24 hours prior to the scheduled trip regarding my request to withhold my child from the trip. I understand that on the day of the trip my child must have with him/her a government issued photo ID. I also authorize any medical treatment in case of emergency and agree that I am responsible for the cost of such treatment. By my signature below, I agree to release, hold harmless and indemnify Entergy, Westchester Community College, and all related agents, representatives and associates with this program from all claims, damages and other liabilities for injuries my child might incur which are not the result of gross negligence, intentional neglect, or willful or wanton conduct by the school or its agents, representatives, or employees. Parent/Guardian Signature / / Date
Release Form Photo and News I agree that my child s photograph and/or information about him or her, including quotes from interviews, can be used in articles about Westchester Community College, or to promote the Summer Energy Camp in publications, advertising, and publicity. This permission is given by me with no expectations of remuneration. Print Parent/Legal Guardian s Name Signature Date Address E-Mail Phone Academic Program Summer Energy Camp
Field Trip Form The following information is required of all participants in order to attend the field trips to the Entergy Indian Point facility and the Con Edison facility. Please print all information. Full Name Address Phone Emergency Contact Number Date of Birth / / Day Month Year Social Security Number - - Code of Conduct for the Field Trips 1. Wear long pants only 2. Wear camp t-shirt 3. Wear shoes (no sneakers or open toed shoes) 4. Bring camper s government issued ID A. Passport B. Driver s License C. Public School ID Card (Unfortunately, private school ID cards cannot be used) 5. Cameras and camera phones strictly prohibited 6. If not a citizen, child must bring a copy of your visa or green card Signature Date Parent/Legal Guardian Signature
Code of Conduct Summer Energy Camp The Code of Conduct has been developed to ensure that everyone has a safe, healthy and enjoyable time on campus. Participants are expected to study these and be familiar with them before arriving and to abide by them while they are here. 1. Participants are expected to be attentive in classes and activity sessions, to be well behaved and cooperative at all times and to follow instructions of the faculty and other summer program staff members. Students who cause a disturbance or in any way interfere with instruction or any other aspect of the camp s experience may be removed from the class or activity. 2. Once you have registered for the camp, you may not leave the campus grounds for any reason, unless accompanied by a member of the Summer Energy Camp Staff or your parent/guardian. 3. Class attendance is mandatory and will be monitored. You will receive a detailed daily schedule when you arrive. You are responsible for getting yourself to the campus on time and must attend all program activities. Please do your best to wake up on time and be ready to attend breakfast each day. If you become ill and cannot attend camp that day, you must notify the camp office at 914-606-6598. 4. Nametags must be worn so that they are clearly visible and readable at all times. 5. Use of cell phones during the course of the camp session is prohibited. 6. All participants must abide by New York State laws. 7. No obscene or lewd language or behavior is permitted. 8. Westchester Community College is a Tobacco Free Campus. Smoking or the use of other tobacco products is strictly forbidden while on campus. 9. You are to dress professionally. No tank tops, short-shorts, ripped jeans, etc. are allowed. Because students may be working with heavy material and because of the requirements of Entergy and Con Edison, you are to wear closed toed shoes each day. 10. For safety reasons, you must wear the camp t-shirt on the days of the field trip. I have read the above rules and agree to abide by them during my time in attendance at the Summer Energy Camp, Signature Date Parent/Legal Guardian Signature
Please Keep for your records. Report absence: 914-606-6598 College General Number: 914-606-660 Camp Counselor: 914-606-6679 Camp Director: 914-606-6658 Daily Schedule Day 1: On Campus Electricity basics, power generation, model windmills, and basic circuits and Ohm's Law. Day 2: Field Trip Con Ed Learning Center Careers in Energy Day 3: On Campus Energy grid, power distribution, nuclear power basics, solar and green energy sources, and build solar power model cars. Day 4: Field Trip Indian Point Nuclear Reactor Day 5: On Campus Power distribution, career speakers, college options and programs. Project completion and ceremony at noon.