Summer 2023 HS Programs Application

Thank you for your interest in applying for 2023 SEED/STEM summer programs affiliated with the IUPUI campus and the IU School of Medicine. Please complete this application as accurately and honestly as you can.

Students currently in grades 10, 11 and 12 are prioritized. In some circumstances, students currently in 9th grade may be accepted.

The application has multiple parts/pages. You are able to save your work at any time and then return to it by clicking the 'Save and Return' button at the bottom.

There are two additional REQUIRED parts of the application:

1) A parent application

2) A recommendation from a teacher

You will receive an email (to your non-school email) when you complete this form with more information on these two additional steps. Links to both are found here: https://indianactsi.org/researchers/education-training/k-12stem/

All application material must be submitted by March 1, 2023. For questions, please email ctsipath@iupui.edu.

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To preview the entire application, click here:

Attachment:Summer2023HighSchoolStudentSEE.pdf

Last Name. Please provide your last name as it appears on your social security card, or other similar official documents. If your last name is more than one word, please include it here with caps, or no caps the way it appears on your documents -example: de la Vega.

* must provide value

First and Middle Names. Please provide your first and middle names the way they appear on your social security card, or other similar official documents.

* must provide value

Personal Email. IMPORTANT: This is DIFFERENT than your school email. Make sure the email address you provide here is working for you. This is the email where you will receive the follow up information and status updates about your application as many school emails block outside messages.

* must provide value

Your personal email again to ensure accuracy.

* must provide value

Please double check your personal email entries - they do NOT match

Phone number where you are best reached?

* must provide value

Name of Parent(s) or Guardian(s) that you live with. If you have a shared custodial arrangement, please add name/s of other custodial parents on the next question.

* must provide value

Name(s) of Additional Custodial Parents or Legal Guardians with shared custody.

Home Address. Enter your complete address here including city, state and zip code

* must provide value

Best phone number where one of your parents can be reached

* must provide value

If you need to take a break to get your parents email address, choose the 'Save & Return Later' option at the bottom of this form. Please be sure to enter your email into the system so they can send you the form with your saved info.

Parent email. Please provide an email address for the parent/guardian where you live who will complete the parent portion of the application. Please enter the correct email.

* must provide value

Parent email 2. If possible, provide an email address for a second parent.

Which high school do you attend?

* must provide value

Expected Graduation Year

* must provide value

Please note: Students currently in grades 10, 11 or 12 are prioritized. In rare instances students who are currently in 9th grade may be accepted.

Date of Birth

* must provide value

Gender

* must provide value

Race

* must provide value

Ethnicity

* must provide value

Are you a citizen of the United States?

* must provide value

Are you a Permanent Resident of the United States with a Permanent Resident ''Green Card'' or USCIS Form I-551?

Please describe and explain your citizen or immigration status. Please provide sufficient information for program directors to know how to best support you.

* must provide value

Expand

If accepted for the program, how will you travel to your internship location?

* must provide value

Please describe transportation plans

Expand

Some internship locations may require students to be fully vaccinated. Which option best describes your vaccination status?

* must provide value

Please provide details regarding vaccination status

* must provide value

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.