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Summer 2025 SEED/STEM Parent Form

Thank you for supporting your child's application to the 2025 SEED/STEM Program, affiliated with the IUI campus and the IU School of Medicine.

Please complete this Parent Information Form as accurately and honestly as possible.

Our program offers stipends ($4,000) to students who demonstrate financial need. To help us assess eligibility, we ask for details about the number of individuals in your household and your household income. We understand that this is sensitive information and want to reassure you that it will only be shared with the program committee and kept confidential.

This form is a required part of your child's application, and must be submitted by March 1, 2025.

Acceptance notifications will be sent via email in April 2025. If your child is selected, we ask for a full commitment to the program during the summer (June 2 - July 24, 2025).

If you have any questions or concerns, please don't hesitate to contact us at ctsipath@iu.edu.

First Name of Student.

Please enter the student's first name.

* must provide value

Last Name(s) of Student.

Please enter the student's last name(s).

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

* must provide value

First Name.

Please provide your first name.

* must provide value

Last Name(s).

Please provide your last name(s).

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

* must provide value

Email Address.

Please provide your personal email.

Note: The email address you provide will be used to send follow-up information and status updates regarding your student's application.

* must provide value

Phone Number.

Please provide the phone number where you can most easily be reached.

* must provide value

Communication.

What is the best way to communicate with you?

* must provide value

What is the best way to communicate with you?

* must provide value

Name of second parent/legal guardian.

Contact information for second parent/guardian.

Affiliations.

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

* must provide value

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

Financial/Household Information.

While we strive to provide stipends for all students, due to limited resources, priority is given to students from socioeconomically disadvantaged households. The information provided below will help our program committee prioritize stipend distribution.

If selected to receive a stipend of $4,000, you may be asked to submit supporting documentation at a later date. This may include, but is not limited to, tax forms, proof of eligibility for reduced or free lunch programs, or similar documents.

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

* must provide value

2024 Household.

Including adults and children, what is the number of people in your household that you reported/ will report on your 2024 IRS tax filings?

* must provide value

2024 Adjusted Gross Income.

What is the adjusted gross income reported/ will report on your 2024 tax return?

* must provide value

2023 Household.

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

* must provide value

2023 Adjusted Gross Income.

What is the adjusted gross income reported on your 2023 tax return?

* must provide value

Transportation.

If your student is accepted into the program, how will they travel to their internship location?

Please describe your student's transportation plans.

Program Benefits.

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

* must provide value

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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?

* must provide value

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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 challenges?

* must provide value

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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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