National Youth Science Camp



Please mail this completed packet to:

Bill Fulton, Science Specialist, Rm 107-A

Arkansas Department of Education

4 State Capitol Mall

Little Rock, AR 72201

501-682-4471

bfulton@arkedu.k12.ar.us

APPLICATIONS MUST BE RECEIVED BY

MARCH 15, 2000

Personal Information

The information given on this page will be used in the administration of the selection process, and will not be shared with the Selection Committee until after the committee has made its decision. All subsequent pages will be identified by the nominee’s Social Security number. If no number is supplied, a random number will be chosen to identify the following pages. The nominee’s name, high school, or any other information which could uniquely identify the nominee should not be used in the following pages. Any specific references to name, high school, etc. will be omitted from the information given to the Selection Committee.

Nominee’s Name

Home Address

Home Phone

Parents’/Guardians’ Names

Nominee’s High School

School Address

High School Principal

Sponsoring Teacher

Academic Performance

This page is to be completed by the sponsoring teacher, counselor, or principal.

Nominee’s Class Rank

Number in Graduating Class

Grade Point Average

Date this information was current

Standardized Test Scores

(if not completed, leave blank)

|SAT |ACT (Score / Percentile) |National Merit Scholarship |

|Verbal: |English: |Selection Index: |

|Math: |Math: |Verbal: |

| |Reading: |Math: |

| |Sci. Reas.: | |

| |Composite: | |

Please attach an official school grade transcript.

Teacher’s Recommendation

Please direct your statement to the following general criteria:

• Academic proficiency

• Leadership

• Activities, skills, and achievements

• Motivation, integrity, and other personal traits

• Ability to serve as a host representing the people of West Virginia

Attach additional pages as necessary.

Principal’s Recommendation

Please direct your statement to the following general criteria:

• Academic proficiency

• Leadership

• Activities, skills, and achievements

• Motivation, integrity, and other personal traits

• Ability to serve as a host representing the people of West Virginia

Attach additional pages as necessary.

Nominee Information

Several categories related to you, your achievements, and your activities are included on the following pages. Please try to be complete in describing yourself. It is through your responses that the Selection Committee gets to know you, your interests, and your plans.

The National Youth Science Camp will be held between June 29 and July 24, 2000. Will you be available to participate during this entire period if you are selected? (circle one)

YES NO

Comments:

Career Plans

Participants must be planning a career in a science or related field. Briefly describe your career plans.

Academic Awards

List those academic awards you have received. Briefly describe the award if the title is not descriptive. Which awards are most meaningful to you and why?

Leadership Activities (School and Community)

We are particularly interested in your role within the groups to which you belong. What offices have you held? What is the function of the organization? How do you contribute to the group?

Honors and Achievements (non-academic)

Have you been recognized by the school or community for something you have done outside the classroom?

Skills and Interests

What are your hobbies? Do you play a musical instrument? Do you participate in a sport? Are you a mechanic? Do you participate in theater? List any unique skills and talents you have.

Statement of Goals

Write a short statement describing your goals and aspirations.

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