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BIOGRAPHICAL INFORMATION
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Email
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Your email
Cracking the Code with Project Steam Ahead!
Full Name:
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Your answer
Gender:
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Male
Female
Other:
Race:
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Black or African American
Hispanic or Latino
Native American or Alaska Native
White
Asian
Native Hawaiian or Pacific Islander
Other:
Date of Birth: ( i.e. MMDDYYY)
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MM
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DD
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YYYY
CONTACT INFORMATION
Street: (and apt)
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City :
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State/Zip:
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Student Email:
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Student Phone Number ( Home)
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Student Phone Number ( Mobile)
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Parent Name:
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Parent Phone ( Mobile)
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Parent Email:
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EDUCATION:
Name of School:
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School Address /City/State
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Grade in 2023/2024
6 Grade
7 Grade
8 Grade
9 Grade
10 Grade
11 Grade
12 Grade
Level
6 Grade
7 Grade
8 Grade
9 Grade
10 Grade
11 Grade
12 Grade
Level
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REFERENCES
(1) Reference Name:
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(1) Reference Email:
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(1) Reference Phone number:
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(2) Reference Name:
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(2) Reference Email:
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(2)) Reference Phone number:
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EXTRACURRICULAR ACTIVITIES/Hobbies
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PROGRAM INTERESTS
Camp Atwater (ages 12-15)
Youth Leadership Summit (14-17)
Volkswagen /GWUL Future Leaders in Mobility Program (rising HS Juniors and Seniors)
STEM programs (Middle School - High School)
Shakespeare Theatre Arts Camp (Middle School)
Urban League Guild Internship (High School community service hours)
Community Service
Project STEAM Ahead (6th-11th grade)
February 1, 2024
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