2023 SEED/STEM Research Program - Parent Information Form

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Thank you for your helping support your child in applying for 2023 summer programs affiliated with the IUPUI campus and the IU School of Medicine. Please complete this parent information form as accurately and honestly as you can.

Our program aims to provide stipends (maximum of $3,200) for students who have financial need. To help determine this we require information about the number individuals in the household and household income. We recognize that this is sensitive information but assure you that it is not shared byond the program committee.

This form is required for a student's application to be considered and must be completed by March 1, 2023. For questions, please email ctsipath@iupui.edu.

First Name/s of child for which this form is being completed:

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Last Name/s of child for which this form is being completed:

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Full Name of Parent or Legal Guardian completing this form (Last, First)

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Parent email address

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What level of education have you completed:

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Describe other degree

Describe your current employment or occupation

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Name of other parent or legal guardian (Last, First)

Other parent email address

What level of education has this parent completed:

Describe other degree

Describe other parent's current employment or occupation

Is either parent employed or otherwise affiliated with the IU School of Medicine, the IUPUI campus, Eli Lilly and Company, Elanco, Corteva, Covance, Roche, the IBRI, or 16Tech?

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Please explain your affiliation to institution(s) listed above

From your perspective as a parent, how would your child benefit from participation in one of these programs?

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Financial/Household Information.

While we strive to provide stipends for all students, limited resources result in us prioritizing support to students from socioeconomically disadvantaged households. Thus, our program committee uses the information provided below to prioritize student stipends.

If selected to receive a stipend (maximum $3,200), documentation may be requested/required at a later date. Examples of documentation that may be requested include tax forms, student eligibility for reduced/free lunch programs, ect.

Which option best describes your child's potential participation?

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Including parents and children, what is the number of people in your household that you reported on your 2022 IRS tax filings?

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Which is the adjusted gross income from your 2022 tax return?

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Including parents and children, what is the number of people in your household that you reported on your 2021 IRS tax filings?

* must provide value

Which is the adjusted gross income from your 2021 tax return?

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If there is anything you would like the program committee to know about financial circumstances please describe.

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