Teen Advisory Board Student Application

2013-2014 School Year

Please submit this application by Wednesday, May 15, 2013 at 5pm.

Questions? Contact Lynn Cross at 919.707.9882.

Name *

Street Address *

City *

Zip *

Home Phone *

Birth Date *

Month

Day

Year

Your email address *

School Name *

Grade Next Year 2013-2014 *

Current Science Teacher's Name *

School Phone *

Parent/Guardian Name *

Parent/Guardian Phone *

Parent/Guardian email *

Second Parent/Guardian Name

Second Parent/Guardian Phone

Second Parent/Guardian email

Questions

Why do you want to be on the Museum's Teen Advisory Board? *

What would you contribute to the Museum by serving on this Board? *

How would serving on the Teen Advisory Board help you achieve your personal, professional, and/or academic goals? *

Which areas of science interest you most? Why? *

What is your favorite way to spend your free time? Why? *

Do you read books, magazines, or articles about science? If so, list some you have read recently. *

What activities, clubs or school groups are you presently involved with? How much time do you spend on each activity per week? *

Do you follow current events about how technology is used to make advancements in science? *

Yes

If so, please list some of the recent achievements that excite you and what sites and/or sources you use to obtain your information. *

What do you consider to be your best personal qualities? *

Please include a picture of yourself enjoying the outdoors.

Acceptable formats are .jpg, .gif and .png. Files should be under 4MB. YOU MUST CLICK THE UPLOAD BUTTON after choosing your photo, or we won't be able to see it!

All Teen Advisory Board members must have and maintain an overall "B" academic average each semester to maintain membership in the program.

This certifies that the applicant has maintained an overall "B" average for the current school year. *

Parent/Guardian name

Parent/Guardian check to sign *

Yes

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Teen Advisory Board Student Application

2013-2014 School Year