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2020 NCIA/MATC Sovereign Native Youth STEM Leadership Academy - Application Form


Deadline: Friday, May 1, 2020



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* Required

All information provided will remain confidential.

First name: *
Middle name:
Last name: *
Email: *
Home address: *
Apartment/unit:
City: *
State: *
Zip: *
Home phone: *
Cell phone:
Emergency contact: *
   Phone: *
   Alt. Phone:
Alt. Emergency contact: *
   Phone: *
   Alt. Phone:
Tribal affliation: *
Enrollment number:
Shirt size (polo): *
Shirt size (t-shirt): *
Gender: *
Age: *

In order to accommodate the needs of our participants and make necessary preparations in advance, the following information must be provided. The information provided in response to the three prompts below will not be considered in the evaluation of applicants.

Dietary restrictions/Food allergies (if any): *
Please detail any medical issues or medications that we should be aware of: *
Participation in the program requires moderate exercise, such as daily walking to and from activity sites. We welcome applicants of all abilities, so please indicate below if accommodations are needed to participate. *
What school do you currently attend?*
Grade level entering in the fall: *
What is your interest in science? *
What is your interest in mathematics? *
We would like to pair you with a mentor who is pursuing a degree in a field that is of interest to you. Please select the category that you are most interested in pursuing.*
STEM (e.g., science, technology, engineering, math)
Arts (e.g., visual, multi-media, music, dance, theater, etc.)
Social Sciences (e.g., psychology, economics, sociology, Native American Studies, etc.)
Humanities (e.g., languages, classics, creative writing, etc.)
Law
Business and Finance
Other (please specify below)
We are looking for Native youth who represent each of the categories below. Which area best describes you?*
Already an established leader
Becoming a leader (have had some experiences)
Could be a leader (shows interest but needs skill and opportunity)


Note:If you are facing any technical difficulties with this application, please contact Utkarsh Hardia

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