STEM Institute – Science, Technology, Engineering, Math
STEM INSTITUTE
The City College
of
THE CITY UNIVERSITY OF NEW YORK
Convent Avenue and 140th Street, Room T-2M11
New York, NY 10031
THE STEM INSTITUTE TEL: (212) 650 – 8172/6190
FAX: (212) 650 - 8139
E-MAIL: marte@ccny.cuny.edu
STEM Institute 2017 Application
Note: We highly recommend that you fill out your application online at :
STUDENT INFORMATION
Name: __________________________ _________________________ _______________________ (Last Name) (First Name) (Your HS OSI #)
Address: ________________________________________________________ Apt #: _____________
City: ______________________________________ State: ___________ Zip Code: ______________
Social Security #: _____________________ Student Cell Phone #:_____________________________
Student’s email address: __________________________________________________________
(Please print)
Date of Birth: ________________ Country of Birth: __________________ Language: _____________
City
Ethnicity: ( Black Non-Hispanic ( Hispanic ( White Non-Hispanic ( American Indian ( Asian-Pacific Islander ( Other (Please specify): _____________________________
Citizenship: ( US Citizen ( US Permanent Resident ( Other: _____________ Sex: ( F ( M
Did you attend The STEM Institute before? ( No ( Yes. If Yes, When: Summer of ___________
PARENT INFORMATION
Parent(s)/Guardian’s Name: ____________________________________________________________
Home Phone #: _________________________ Work Phone #: ________________________________
EDUCATION INFORMATION
Current Grade: ? 9 ? 10 ? 11 ? 12 When Entered 9th Grade: _________ When will Grad. _____ HS Avg.: __________ Math Avg.: _________ SAT Scores: Math: __________ Verbal: ___________
ACT Score(s): Math _____ Reading: ______ English: ______ Chemistry: ______ Phys:______
Are you eligible for FREE or Reduced Lunch? ( Yes or ( No Household size? _________
School Name: _______________________________ Counselor Name: _________________________
Counselor’s email : ___________________________________________________________________
School Address: ____________________________ City: ___________ State: ______ Zip: _________
Tel: _______________________ Extension: ___________
(See back)
Please check ONLY ONE group. Each group has two classes.
Are you planning to be absent more than twice? Please check one: ( Yes or ( No
Please notice: we HAVE Limited space in each class
A. 1. Calculus I (1 elective HS credit) MUST check Option 2 ( 3 ( or 4 (
Option 2. Engineering Design 10100 – Robotics (Non-credit)
Option 3. College Critical Writing & Reading (1 elective HS credit) Pre-requisite: Non-ESL)
Option 4. Biomedical Engineering Research (Non-credit) Seats are limited
Pre-requisite: Pre-calculus with a grade of 90 from HS or C / better from any college
B. 1. College Pre-Calculus (1 elective HS credit) & General College Physics (1 elective HS credit
Pre-requisite: A grade of 90 or better in Algebra 2 or its equivalent
C. 1. Advanced College Algebra (1 elective HS credit) MUST check Option 2 ( or 3 (
Option 2. General Chemistry (1 elective HS credit)
Option 3. College Critical Writing & Reading (1 elective HS credit), Pre-requisite: Non-ESL
Pre-requisite: A grade of 90 or better in Algebra I or its equivalent.
Note 1: You must also submit a copy of your High School Transcript to be considered. See Next page for Transcript Request form.
Note 2: Your transcript and application can also be sent via my secure Dropbox account at
Application deadline: Friday, April 28, 2017
| | STEM INSTITUTE |
| |THE CITY COLLEGE |
| |of |
| |THE CITY UNIVERSITY OF NEW YORK |
| |140th Street & Convent Avenue, RM 2M-11 |
| |New York, NY 10031 |
STEM INSTITUTE TEL: (212) 650 – 8172/6190
FAX: (212) 650 - 8139
E-MAIL: marte@ccny.cuny.edu
Official Transcript Request
Students: Please ask your parent or guardian to fill out this form, deliver it to your school counselor, make arrangements for pick up or your school can send (upload) it to my secure drop box account at . Subject: Student Name’s Transcript
Thank you.
Dear School Counselor,
My son/daughter ___________________________________ needs to submit an official transcript to the 2016 The STEM Institute.
Would you please arrange to provide him/her with the official transcript or send it directly to the above address. Thank you.
Sincerely,
__________________________________ _______________________
Signature of Parent/Guardian Date
Application deadline: Friday, April 28, 2017
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