Form Es-Nhq-090517-0494 - Women In Technology Student Application Form printable pdf download

Form Es-Nhq-090517-0494 - Women In Technology Student Application Form

Women in Technology Student Application Form

Please complete (typed or written clearly) and return this application form, along with completed admission essay and

waivers, to Stephanie Livsey () by September 19, 2017.

STUDENT INFORMATION

Name (First, Last):

Date of birth:

Are you a US citizen?

T-shirt size (unisex):

Preferred form of communication (email or

Telephone:

Email address:

text message):

Current address:

City:

State:

ZIP Code:

Have you participated in FIRST Lego League?

Have you participated in FIRST Robotics?

Do you have any programming experience? If so, please list languages:

Do you know anyone who works at BAE Systems? If so, who?

Do you have a reliable form of transportation to all BAE Systems locations?

Yes

(Nashua, Canal Street; South Nashua; Merrimack; Hudson)

Do you expect that you can attend 100% of the scheduled sessions?

Yes

(Tuesdays from 1:30-3:30pm) If no, please elaborate:

SCHOOL INFORMATION

School Name:

Current grade level:

GPA (4.0 scale preferred):

EMERGENCY CONTACT

Name:

Relationship to student:

Best phone number to call:

Alt. contact:

Alt contact phone:

Relationship:

If selected, you will be required to present an original birth certificate, passport, or I-551 card AND a photo ID on the first

day. You will not be allowed into the building without these items.

Parent/guardian Signature: ___________________________________________________________

ES-NHQ-090517-0494

Form Es-Nhq-090517-0494 - Women In Technology Student Application Form