February 21, 2017 Dear Parent/Guardian: This is a letter to invite your student to participate in Summer Academy to Inspire Learning (SAIL) program - a FREE weeklong day camp at Portland State University (PSU). This day camp will be held on the PSU campus in Portland from Monday, July 17 th, through Friday, July 21 st, 2017. The camp will run from 10AM to 3PM each of the five days. The mission of SAIL at PSU is to encourage promising middle and high school students from underserved communities on a path to college. The program is run by volunteer faculty and staff. We will provide lunch each day, and a TriMet pass if your student needs one to get to campus. Activities each day will consist of a mixture of discussions with our faculty and college students from different disciplines and visits to the library, bookstores, art museum, and PSU laboratories. We will also provide some advice from the PSU admissions office about how your student can start preparing for college while they are in high school, and some information about scholarships and financial aid. For more information on previous camps at SAIL, please visit: http://www.pdx.edu/sail. To enroll your student, please fill out the enclosed Application and Enrollment Form (Sections I and II) and return these to us by May 30 th, 2017. Please mail all materials to: ATTN: SAIL PROGRAM COORDINATOR Department of Economics Portland State University PO BOX 751 PORTLAND, OR 97207 0751 Should you have any questions, please do not hesitate to contact us: Joshua Winicki (ph: 503.267.2562; email: fjwinicki@gmail.com) or Rossitza Wooster (ph: 503.725.3944; email: wooster@pdx.edu). Sincerely, Josh Winicki, PhD and Rossitza B. Wooster SAIL at PSU Associate Director Associate Professor of Economics Portland State University Portland State University
Application SAIL AT PSU WILL BE HELD JULY 17 21, 2017 Instructions: Please complete this application, and return to the Department of Economics at PSU along with the attached enrolment forms by May 30 th, 2017. NAME PARENT OR GUARDIAN(S) ADDRESS CITY STATE ZIP CODE HOME PHONE ALTERNATE PHONE E MAIL ADDRESS: SCHOOL NAME: GRADE IN 2016 2017: WHO REFERRED YOU TO SAIL? (NAME AND PHONE NUMBER) PARENT OR GUARDIAN(S) SIGNATURE STUDENT SIGNATURE Do you qualify for FREE AND REDUCED COST LUNCHES? YES NO Will you need TriMet passes? YES NO
Summer Academy to Inspire Learning at Portland State University (SAIL@PSU) 2017 General Information DAILY SCHEDULE: 10:00 AM 3:00 PM DAILY, JULY 17-21, 2017. Activities begin promptly at 10 AM. Students should plan on arriving 15 minutes early and camp counselors will be on hand to meet students starting at 9:45 am each morning at the Urban Plaza (in front of the PSU Bookstore on 5 th and Montgomery in downtown Portland). Please see attached enclosed map. There is a one-hour supervised lunch break. We will provide a free lunch on campus or nearby. Camp will be over at 3:00 PM. If your student is not using TriMet, you may make arrangements to pick them up at campus. If your student will be late to camp, or needs to be picked up early, you can call Rossitza Wooster at (971) 998-6963, or Joshua Winicki at (503) 267-2562. SUPERVISION Like you, our primary concern is the safety and security of each student. There will be at least one university staff member and one graduate or undergraduate camp counselor present at all times. Each student will be made familiar with PSU safety and security policies upon arrival. We will provide supervision while the students are in class or enjoying leisure time on campus. As educators and substitute parents for the week, we take our job very seriously. Please note: we are unable to supervise students outside of camp hours (10:00 am 3:00 pm). WHAT TO BRING (Please label all items with name.) Water bottle Any necessary inhalers, allergy medicine, or prescription medicines indicated on the enclosed Health Form WHAT NOT TO BRING Alcohol, drugs, or tobacco (Possession and/or consumption of alcohol, tobacco, or drugs is prohibited and cause for dismissal from SAIL-PSU.) We will provide students with all necessary school supplies notebook, pencils, and so on. EMERGENCY PROCEDURE In case of an emergency requiring you to contact a student, please observe the following procedures: Call Rossitza Wooster at (971) 998-6963, or Joshua Winicki at (503) 267-2562. We will contact your student. MEDICATION, ILLNESS, OR INJURY Please provide information on the Health Form about any prescription medicines that your student is bringing to camp. Please indicate on the enclosed Health Form your preference for a Portland-area hospital to which your student should be taken in case of an emergency. CANCELLATIONS If your student will be unable to attend camp, or will miss part of it, please contact us right away. Please retain this sheet for reference.
SAIL@PSU 2017: RULES AND DISCIPLINARY PROCEDURES As a University sponsored program, we (staff) and you (parents and participants) are bound by the University Code of Student Conduct. Under this code, Portland State University may initiate disciplinary action and impose sanctions against any student found guilty of committing, attempting to commit, or intentionally assisting in the commission of any of the following prohibited forms of conduct: 1. Damage, destruction, theft, or unauthorized use of personal property located on the University campus or property owned or controlled by the University. 2. Illegal use, possession, or furnishing of dangerous or narcotic drugs on University owned or controlled property or at University sponsored or supervised activities. 3. Possession or consumption of alcoholic beverages by persons under 21 years of age, or furnishing of alcoholic beverages to persons under 21 years, on University owned or controlled property or at University sponsored or supervised activities. 4. Tampering with fire-fighting equipment, turning on a false alarm, or engaging in behavior that constitutes a significant fire hazard. 5. Hanging or climbing through windows, or on roofs or ledges. In addition to the above listed University regulations, our program has established the following rules to insure the health and safety of all participants. 1. No student shall leave camp except when approved by a SAIL@PSU Administrator. 2. Students will attend all designated classes, activities, and special events during the program on time and in an appropriate manner. 3. Students will be prompt for the beginning of camp activities each day at 10 AM. 4. No possession or use of weapons or combustible materials (including fireworks and cigarette lighters) is allowed. 5. Use of obscene language will not be tolerated and repeated use may be grounds for expulsion. 6. Intimidation of others with violence or the threat of violence or other forms of harassment is strictly prohibited. 7. Participants shall not take part in, or facilitate, discrimination based on race, gender, national origin, ethnicity, age, religion, sexual orientation, disability or handicap. In addition to any action taken by the University, SAIL@PSU will initiate the following procedures in the event a student is involved in any of the previously listed prohibited activities: 1. The Program Coordinator will be apprised of the situation and will discuss it with the student. 2. The student s parent(s)/guardian(s) will be notified of the incident. 3. Disciplinary action, possibly including expulsion from the program, will be initiated. Please retain this sheet for reference.
ENROLLMENT FORM: COMPLETE AND RETURN BY MAY 30 TH, 2017 TO GUARANTEE ENROLLMENT SECTION I: CONSENTS STUDENT S NAME: HOW WILL THE STUDENT GET TO SAIL@PSU (MAX, BUS, DROP-OFF, ETC.)? ACTIVITY: SAIL@PSU SUMMER CAMP PROGRAM The undersigned hereby acknowledge receipt of the Rules and Disciplinary Procedures and agree to abide by these rules, regulations, and sanctions. I understand and agree: 1) That the Oregon Tort Claims Act (ORS 30.260 to 30.300) permits Portland State University to accept responsibility only for the acts of its officers, employees, and/or agents. Portland State University is prohibited from accepting any liability for the acts, omissions and conduct of persons participating in activities. 2) That I shall indemnify, defend and hold harmless the State, Portland State University, its officers, agents and employees from all claims, suits, or actions of any nature arising out of my student s participation in the activity other than negligent acts of Portland State University, its officers, employees, and/or agents. 3) As Parent/Guardian of, (name of student) I agree that SAIL@PSU may access and use information relating to financial aid, grades, class standing, transfer records, or any other relevant information, for administration, statistical and research purposes. Information used for statistical purposes will not have individual names or personal identifying information connected to it. NAME OF PARENT / GUARDIAN: SIGNATURE OF PARENT / GUARDIAN: DATE: SIGNATURE OF STUDENT: DATE: PROMOTIONAL RELEASE - (PLEASE INITIAL ONE) Approval for promotional use of student s photograph or video (YES) I, the parent or guardian of the student, give permission for my student s photograph or video to be used for PSU promotional materials (brochures, website, etc.). Photographs and videos are never accompanied by last names. (NO) I, the parent or guardian of the student, do not give permission for my student s photograph or video to be used for PSU promotional materials.
SECTION II: HEALTH FORM STUDENT S NAME: SEX: BIRTH DATE: ADDRESS: CITY: STATE: ZIP CODE: CONTACT EMAIL ADDRESS: RACE (please check one) Asian Black or African American Hispanic or Latino White or Caucasian Other T-Shirt Size (please check one) X-Small Small Medium Large X-Large In an EMERGENCY, SAIL@PSU WILL FIRST CONTACT THE PARENT/GUARDIAN. If we are unable to reach the parent or guardian, please provide an additional contact under (3) below: 1) PARENT/GUARDIAN #1 NAME: WORK PHONE: 2) PARENT OR GUARDIAN #2 NAME: WORK PHONE: HOME PHONE: CELL PHONE: HOME PHONE: CELL PHONE: 3) ADDITIONAL CONTACT NAME: RELATION TO STUDENT: PHONE(S): STUDENT S DOCTOR: PHONE: STUDENT S DENTIST: PHONE: Describe any medical condition or potential allergic reactions that camp personnel should be aware of (If necessary, attach a separate page with more specific instructions). List all medications taken at home and that may be in your student s possession while participating in SAIL@PSU. Date of last tetanus shot (booster required every 10 years):
-- OVER-- Does this student have a medical condition that requires a special diet or special consideration in physical activities? Please specify the condition and the instructions for the diet or special considerations. Does this student require any special accommodations related to disability? Please explain. THIS FORM IS IN EFFECT ONLY FOR THE TIME OF YOUR STUDENT S ATTENDANCE AT SAIL@PSU SUMMER CAMP PROGRAM. STUDENT S NAME: If deemed advisable by the SAIL Economics Camp Coordinator, I hereby give my permission for nonprescription medication (Tylenol, Neosporin, etc) to be given to my student. PLEASE CIRCLE ONE: Yes, I give permission. No, I do not give my permission. Signature of parent or guardian: In the event of an emergency, I request that my student be taken to: (Provide name of local area hospital) Furthermore, it is understood that in case of serious illnesses or emergencies, I, or emergency contact, will be contacted immediately. In the event that SAIL@PSU personnel are unable to reach any of the emergency contacts listed above, I, parent/guardian of (name of student) authorize SAIL@PSU personnel to seek and authorize medical care. Any direction to the contrary needs to be specified on a separate sheet of paper and signed by the parent or guardian and attached to this enrolment form. Signature of parent/guardian: If your student is covered by medical /dental insurance, please complete the below. You do not need to have insurance for your child to participate. Medical Insurance Carrier, Group and Policy Number: Medical Insurance Carrier, Phone Number: Dental Insurance Carrier and Policy Number: Dental Insurance Carrier Phone Number: