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Student Camp Application Form

2013 Engineering and Computer Science Summer Camps


The University of Texas at Arlington College of Engineering
Student: Please supply all requested information. Please print or type. If student uses a nickname, please list
in parentheses after first name. You are welcome to attach a small photo of your student with this application.

Last Name _____________________________First ______________________M. I. __________


Address________________________________________________________________________
City, State Zip ___________________________________________________________________
School Currently Attending _________________________________________________________
Age _____ Gender _____ Current Grade _____ School District_____________________________
Name of Teacher Providing Evaluation________________________________________________
Check the box to select one camp choice based on the grade you will enter in Fall 2013:
Access to Engineering day camp (9th, 10th or 11th grade): June 17 21
BRIDGE TO ENGINEERING residence camp (9th or 10th grade): June 23 28
Gateway to Engineering residence camp (7th or 8th grade): July 7 12

Entry to Engineering day camp (6th, 7th or 8th grade): July 15 19


Girlgeneering day camp (5th, 6th, 7th, 8th or 9th grade): July 29 August 2
Please describe any extracurricular activities ___________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Please describe any awards and honors ______________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Have you attended a UTA Engineering Summer Camp before?

Yes

No

If yes, which camp(s) and year ________________________________________________


Parent/Guardian: Name ___________________________________________________________
Home Phone ______ - _________________ Work Phone ______ - _________________________
Parent Cell _____ - _______________ Parent E-mail_____________________________________
Student Cell (Optional) _____ - _______________ Student E-mail (Optional)__________________
I acknowledge that he/she has my permission to attend the UT Arlington College of Engineering's
Summer Camp Program. I understand that he/she will be subject to the rules and program
requirements of the Summer Program.
Signature ______________________________________________________________________
Date___________________________________________________________________________
Application Deadline: Access and Bridge postmark by April 1st
Gateway, Entry and Girlgeneering postmark by April 15th

Questions can be directed to engineeringoutreach@uta.edu or (817) 272-1295.

Camp Application Form (continued)


2013 Engineering and Computer Science Summer Camps
The University of Texas at Arlington College of Engineering
Student: Please hand print you answers to the following questions and statements.

Your Name _____________________________________________________________________

(1) Describe an example of how engineering positively affects you, your family, or your friends in
everyday life. ____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
(2) What would you like to find out about engineering by participating in an Engineering Summer
Camp? _________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
(3) What do you think of when someone suggests that you could be an engineer?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
(4) Do you know anyone who is an engineer? Who is it and what do you know about their job?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
These responses are my own work and have not been edited by others. I understand that I
must attend and participate in all scheduled classes and events throughout the duration of
the program (unless unable to do so because of an excused absence such as illness). I
agree to abide by the rules and program requirements of the Engineering Summer Program.

Signature _______________________________________________________________________
Date___________________________________________________________________________