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Summer 2024 High School Research Program Parent Form

Thank you for your helping support your child in applying for the 2024 SEED/STEM Program 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 $4,000) 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 beyond the program committee.

This form is required for a student's application to be considered and must be completed by March 1, 2024.

Acceptances will be emailed April 2024. We ask that students fully commit to the program for the months of June and July (June 3- July 24, 2024). For questions or concerns, please email ctsipath@iupui.edu.

Last Name(s) of Student. Please provide the last name(s) of the student for which this form is being completed for the 2024 SEED/STEM Program.

If the student's last name is more than one word, please include it exactly as it appears on documents. (Example: de la Rosa)

First Name of Student. Please provide the first name of the student for which this form is being completed for the 2024 SEED/STEM Program.

Last Name(s) of Parent/Legal Guardian. Please provide the last name(s) of the parent/ legal guardian completing this form.

If the last name is more than one word, please include it exactly as it appears on documents. (Example: de la Rosa)

First Name of Parent/Legal Guardian. Please provide the first name of the parent/ legal guardian completing this form.

Parent/Guardian Email Address. Please provide your personal email.

Note: Be sure that you can access the email address you provide here as it will be used to communicate follow up information and status updates about your student's application.

Parent/Guardian Phone Number. Please provide the phone number where you can most easily be reached.

Communication. What is the best way to communicate with you?

What is the best way to communicate with you?

Name of second parent/legal guardian. (Last, First)

Second parent/guardian email address.

Is either parent/guardian 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?

Please explain your affiliation(s) to any institution(s) listed above.

Financial/Household Information.

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

If selected to receive a stipend (maximum $4,000), 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, etc.

Which option best describes your child's potential participation in the program?

Household. Including adults and children, what is the number of people in your household that you reported/ will report on your 2023 IRS tax filings?

Adjusted Gross Income. What is the adjusted gross income reported on your 2023 tax return?

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

Adjusted Gross Income. What is the adjusted gross income reported on your 2022 tax return?

From your perspective as a parent, how would your child benefit from participating in the SEED/STEM program?

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Time Management and Organization. How well does your child manage their time, especially when faced with multiple commitments? Can you provide examples of situations where they have effectively balanced their responsibilities and demonstrated time management skills?

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Guidance and Support. How does the student approach problem-solving in academic and non-academic situations? In what ways has your student sought guidance or support when faced with academic challenges?

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Additional Information (OPTIONAL). Please provide any other information or financial circumstances you would like for the committee to consider when evaluating your student's application.

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Enter your name on this line to certify you have completed this form with accurate information.

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