VESTED Academy Application-2011

VESTED Academy Application-2013

Your interest in and commitment to the program are the criteria by which we will make our selection.

APPLICATION and EMERGENCY CONTACT (online), and Waiver (pdf only)
MUST BE SUBMITTED BY: November 2, 2012
PDFs (if you prefer paper forms) - Application, Parents Waiver, Emergency Contact.

General Information

Name:

Date:

Street Address:

City:

State:

Zip Code:

Home Telephone:

Email:

Cell Number:

Name(s) of Parent(s) or Guardian(s):

Current Grade:

(Jan. 2013)

Birthdate:

Age:

High School:

Ethnicity: Are you Hispanic/Latino:

Yes No

Race: Please check one or more that apply:

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander

Reference

Identify a teacher or other adult (not a relative) who knows you, whom we may contact to learn more about your interest in the program as well as your ability to participate. Please inform this person that we may be contacting him or her.

Name:

Position/Subject:

Telephone:

Transportation to Villanova University’s campus

Yes, I will need transportation as provided by the VESTED Academy Program.

Yes

No thanks, I will not require transportation to campus.

How did you learn about the VESTED Academy?

Do you have a regular job or activity after school?
Yes No

If Yes, please describe with days of week and times.

Technology Proficiency

Please rate your proficiency in the following technical skills:
(5=high expertise, 1=little experience):

Physics:

Calculus:

Chemistry:

Biology:

Computer Software:

Written Essays

1. What attracts you to the VESTED Academy and what do you hope to gain from your experience in the program?

2. Who are you as a student? What are your interests, experiences and future goals?

Curriculum Choice (Returning students only)

Please note your desired curriculum track , in order of preference.
(1 = first choice: 2 = second choice)

Lab Track- A program of lab focused engineering and science project-based work, utilizing experimentation and analyses. Results will be recorded in scientific notebooks.

Project Track- Long term study of real world engineering problems based on well defines objectives, scientific analyses and demonstrations.

Interview

Each new applicant is required to complete an interview prior to final acceptance into the VESTED Academy. Returning students are exempt. All interviews will be conducted on December 1, 2012. Please choose your preferred interview time:

Morning Afternoon

VESTED Academy Emergency Contact Information for 2013

Student Name:

Gender:

Male Female

Street Address:

City:

State:

Zip Code:

Date of Birth:

Home Telephone:

Mother/Guradian Name:

Mother/Guradian Phone/Cell:

Father/Guradian Name:

Father/Guradian Phone/Cell:

School:

Grade:

Emergency Contact Name:

Emergency Contact Phone/Cell:

Relationship to Student:

Please list any medical problems or conditions of this student that staff should be made aware:

Is this student currently taking any medication?

Yes No

Please explain: