Center for Bioelectronics STEM Summer Institute (SSI) 2024 Application

Registration: Participants may submit applications and supporting documents beginning February 15, 2024. Deadline for application and supporting documents is Friday, April 19, 2024 at 5:00 pm.
Late or incomplete applications will not be processed by staff.

The application and all supporting documents must be received by May 19, 2024 at 5:00 p.m. Students will be advised of their acceptance by late April 2024.

PART ONE: STUDENT INFORMATION
Name PART ONE: STUDENT INFORMATION
Name * First Last
Date of Birth Date of Birth * / MM / DD YYYY
Age *
Ethnicity/Race *
Phone Phone * - ### - ### ####
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
T-Shirt size *

T-Shirt size X-Small Small Medium Large X-Large 2X-Large 3X-Large
Application for the following program *

Application for the following program STEM Exploration (Rising 6th & 7th Grader) STEM Exploration (Rising 8th & 9th Grader) Technology Exploration (Rising 10th & 11th Grader) Research in Bioengineering (Rising 12th Grader)
Name of School *
Current Grade in School *
PART TWO: PARENT/GUARDIAN
If selected, my child has permission to participate in the STEM Summer Institute (SSI).
I acknowledge that attendance in the Family Orientation Program is mandatory. I understand that this is a residential program.

Name *

If selected, my child has permission to participate in the Bioelectronics STEM Summer Institute Program (BSIP).
I acknowledge that attendance in the Family Orientation Program is Mandatory. I understand that this is a residential program.
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date * / MM / DD YYYY
Phone Phone * - ### - ### ####
Email *
PART III: Counselor/Teacher/School Official *

Provide name of a Counselor/Teacher/School officail
Title *
School *
Email *
Phone Phone * - ### - ### ####
PART IV: SUPPORTING DOCUMENTS *

Attach Files

Upload the following supporting documents:
. Copy of the most recent semester grades and of grades for the past two semesters.
. Copy of the most recent achievement test score(s) (If applicable), i.e. PSAT, SAT, ACT
. List of academic awards/honors and current school activities
. Essay (250 words) answering one of the following questions:
. How have your past accomplishments in science and engineering prepared you for the 2024 Bioelectronics STEM Summer Institute? (250 words), OR
. How will the 2024 Bioelectroncis STEM Summer Institute help you achieve your personal and educational goals? (250 words)
PAYMENT
Please mail your check of $1000 to: Bioelectronics STEM Summer Institute Attn: Victoria Ansah 4211 Monarch Way, Suite 343 Norfolk, VA 23508 Email:vansah@odu.edu Tel: 757-683-5873