STEM INSTITUTE

The City College

of
THE CITY UNIVERSITY OF NEW YORK
Convent Avenue and 140th Street, Room T-2M15
New York, NY 10031
THE STEM INSTITUTE
650 8172/6190

TEL: (212)
FAX: (212) 650 8048
EMAIL:stem@ccny.cuny.edu

STEM Institute 2015 Application

Note: Incomplete applications WILL NOT be reviewed:

Application deadline> April

24, 2015
STUDENT INFORMATION

Name: __________________________ _________________________ _______________________

(Last Name)

(First Name)

(Your HS OSI #)

Address: ________________________________________________________ Apt #: _____________

City: ______________________________________ State: ___________ Zip Code: ______________
Social Security #: _____________________ Student Cell Phone #:_____________________________
Students email address: __________________________________________________________
(Please print)

Date of Birth: ________________ Country of Birth: __________________ Language: _____________

City

Ethnicity:

Black Non-Hispanic
Hispanic White Non-Hispanic
Indian
Asian-Pacific Islander Other (Please specify):
_____________________________

Citizenship: US Citizen
M

US Permanent Resident

Did you attend The STEM Institute before?

American

Other: _____________

Sex: F

No Yes. If Yes, When: Summer of ___________

PARENT INFORMATION

Parent(s)/Guardians Name: ____________________________________________________________

Home Phone #: _________________________ Work Phone #: ________________________________
EDUCATION INFORMATION
Current Grade: 9 10 11 When Entered 9th Grade: __________ When will Grad.

___________

HS Avg.: __________ Math Avg.: _________ SAT Scores: Math:

__________ Verbal: ___________

ACT Score(s): Math _____

Reading: ______ English: ______

Are you eligible for FREE or Reduced Lunch?

_________

Yes or

Chemistry: ______

No

Phys:______

Household size?

School Name: _______________________________ Counselor Name: _________________________

School Address: ____________________________ City: ___________ State: ______ Zip: _________
Tel: _______________________ Extension: ___________ E-mail:_____________________________
AP Courses Completed: _________________, _______________________, _____________________
(See back)
Please check ONLY ONE group. Each group has two classes.
Are you planning to be absent more than twice? Please check one:

Yes or

No
Please notice: we HAVE Limited space in each class
A.

1. Calculus I (1 elective HS credit)

MUST check

Option 2

or

Option 2. Robotics/Engineering Design 10100 (Non-credit)

Option 3. College Critical Writing & Reading (1 elective HS credit) Prerequisite: Non-ESL
Pre-requisite: Pre-calculus with a grade of 90 from HS or C / better from any college

B.

or

1. College Pre-Calculus (1 elective HS credit)

MUST check Option 2

3
Option 2. General College Physics (1 elective HS credit)
Option 3. General Chemistry (1 elective HS credit)
Pre-requisite: A grade of 90 or better in Algebra 2 or its equivalent

C.

or

1. Advanced College Algebra (1 elective HS credit) MUST check Option 2

3
Option 2. General Chemistry (1 elective HS credit)
Option 3. College Critical Writing & Reading (1 elective HS credit), Prerequisite: Non-ESL
Pre-requisite: A grade of 90 or better in Algebra I or its equivalent.

D.

1. Engineering 103 (Computer Methods) (Non-credit) &

2. * Select ONLY one Research area.
A.
Electrical EngineeringB.
Civil Engineering C.
Mechanical
Engineering
C.
Science (Biology, Physics or Chemistry)

Pre-requites: Calculus I (with a grade of C+ or better) or AP Calculus AB (with a score of 4 or

better).

* Note: Group D is only available for students who meet the additional two
conditions:
(1) MUST Be a US Citizens and (2) Must Be a Junior (11th) or Senior
(12th).
REFERENCES: Math and Science teacher recommendations are required.
Please Print:
1.
Math
Teacher:
______________________
________________________________
Last name
First Name

_______________________

2.
Science
Teacher:
_____________________
________________________________
Last name
First Name

_______________________

E-mail

E-mail

STEM Institute 2015 Teacher Recommendation Form

Students Name:
__________________

________________________________________ Grade: __________

Date:

Please indicate which classes your student is applying for:

1. _____________________________________________

2. ____________________________________________

To the Sponsoring Teacher:

Thank you for your recommendation of the above named student for the 2015
Summer STEM Institute. Please send the recommendation form, along with your
recommendation letter to:

Otto Marte, Assistant Director

Email: stem@ccny.cuny.edu

Subject: STEM Recommendation Form/Student Name

URL: http://stem.ccny.cuny.edu

1. Possesses a comfortable knowledge of basic skills and factual information ----------------------------------2. Has ability and desire to follow through on work: able to see a problem through in assigned tasks ---------3. Pursues interests to understand or satisfy curiosity; wants to know how and why. ----------------------------4. Generates questions of his/her own; questions the common, ordinary, or unusual. ----------------------------5. Enjoys the challenge of difficult problems, assignments, issues, and materials. --------------------------------6. Inclined to be independent on his/her own ideas (when appropriate) rather than relying on the structuring of others.
7. Capable of planning and organizing activities, direct actions, and evaluating his/her own results.-----------8. Requires a minimum of adult direction and attention: possesses skills to facilitate independent work. -----9. Seems self-confident, happy and comfortable in most situations. --------------------------------------------10. Is able to cope with normal frustrations or can adapt to change with minimum difficulty. -----------------11. Able to function effectively as a group member. -------------------------------------------------------------------I2. Is receptive to new tasks or experiences; seems able to take reasonable risks. ---------------------------------

Please check the appropriate box:

I highly recommended the applicant
reservation

I recommend the applicant with

I recommend the applicant

I do not recommend the applicant.

Application deadline: Friday, April 24, 2015

(See Back)

The STEM Institute 2015 Teacher Recommendation Letter

To the Sponsoring Teacher:
Thank you for your recommendation. Please take a moment to write a brief
recommendation supporting the candidacy of this student for participation in this
program. Please email your recommendation to: stem@ccny.cuny.edu Subject:
students name
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Teachers Name: _______________________________________________________________Dept: ______________________________
Signature:
_________________________________________________________
_________________________

Phone:

Application deadline:

Friday, April 24, 2015

STEM Institute 2015 Teacher Recommendation Letter

To the Sponsoring Teacher:
Thank you for your recommendation. Please take a moment to write a brief
recommendation supporting the candidacy of this student for participation in this
program. Please email your recommendation to: stem@ccny.cuny.edu Subject:
students name
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Teachers Name: _______________________________________________________________Dept. ______________________________
Signature:
_________________________________________________________
_________________________

Phone:

Application deadline: Friday, April 24, 2015

STEM INSTITUTE
THE CITY COLLEGE
of
THE CITY UNIVERSITY OF NEW YORK
Convent Avenue and 140th Street, RM 2M-15
New York, NY 10031
STEM INSTITUTE

TEL: (212) 650 8172/6190

FAX: (212) 650 - 8048
E-MAIL: stem@ccny.cuny.edu

Official Transcript Request

Students: Please ask your parent or guardian to fill out this form, deliver it to
your school counselor, make arrangements for pick up and mailing or for your
school to mail a copy of your official transcript to the program address above.
It can also be emailed to stem@ccny.cuny.edu
Transcript

Subject: Student Names

Thank you.

Dear School Counselor,

My son/daughter ___________________________________ needs to submit an official
transcript to the 2015 The STEM Institute.
Would you please arrange to provide him/her with the official transcript or send it
directly to the above address. Thank you.

Sincerely,
__________________________________
Signature of Parent/Guardian

_______________________
Date

Application deadline: Friday, April 24, 2015