Elmhurst 2020 Virtual STEM Academy Application

Along with submitting this application, please submit a copy of your high school transcript and the requested essay. If your high school transcript is not available, please send a copy of your last report card. Transcripts/report cards can be uploaded to your application or emailed to transcripts4EU@elmhurst.edu.

Student Information

Last Name

First Name

Preferred Name

Birthdate

Contact Information

Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Mobile Phone Number

Demographic Information

Please select your race(s) from the list below:

Gender

Female

Male

Other

Do you consider yourself Hispanic/Latino?

Yes

No

Are you working with a community based organization or scholarship fund?

Yes

No

Please select:

Please enter:

Are you eligible for free or reduced lunch at your school?

Yes

No

Not Sure

You may be eligible for need-based scholarships. Please ask your school counselor for documentation stating your eligibility for free/reduced lunch.

Academic Information

What semester will you enter college?

Your Expected Major in College

Your Current School

CEEB Code

Level of Study

Will you be taking the Academy for college credit?

Yes

No

Family Information

Relationship to You

Parent 1 First Name

Parent 1 Last Name

Parent 1 Phone Number

Parent 1 Email Address

Highest Level of Education Completed by Parent 1

Relationship to You

Parent 2 First Name

Parent 2 Last Name

Parent 2 Phone Number

Parent 2 Email Address

Highest Level of Education Completed by Parent 2

In 300-500 words describe why you are interested in participating in this program and what you hope to learn from attending the Elmhurst STEM Academy.

High School Transcript

Documentation Regarding Free/Reduced Lunch

By submitting this application, I certify that it is true, correct and honestly presented.

In place of your signature, please type your full legal name:

Signature