Verizon Innovative Learning Application 2023

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PROGRAM OVERVIEW

Through hands-on mentorship, technology, and training, the Verizon Innovative Learning STEM Achievers Program empowers students to discover new problem-solving skills and learn about career opportunities in technology fields.

The Morehouse College Verizon Innovative Learning STEM Achievers Program serves ALL (both female and male) middle school students.

All About You (the Student Applicant)

Tell us about yourself. You are a...*

A NEW middle school participant (current 5th-8th grader) A returning middle school participant (current 5th-8th grader)

How did you hear about the Verizon Innovative Learning STEM Achievers Program?

From a Fall/Spring showcase event From my school / my child's school From a past participant From social media

Other: Other Value

Applicant Name:*

First Name*

Last Name*

What grade will the applicant attend next school year?*

Select the grade that the student participant will be in for the 2023-2024 school year.

Applicant's Current Address:*

Address Line 1

Address Line 2

City

State

ZIP Code

Applicant's Age:*

Applicant's Date of Birth:*

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Month

Day

Year

How does the applicant identify themselves?

Native American Asian Latino White Alaska Native Black or African American Hawaiian or Pacific Islander Decline to state

Other: Other Value

Choose as many as apply.

Is the applicant a United States citizen?*

Yes No

Applicant's Gender:*

The next few questions of this application form should be completed by the student applicant referred to in the previous questions.

Have you ever...*

...used a 3-D printer ...experienced virtual reality ...programmed a computer ...designed a web site

Choose as many as apply.

Tell us about your favorite subjects in school.*

Do the grades you earn make you happy?*

How would you rate your academic performance? *

In 200 words or less, tell us how the Verizon Innovative Learning (VIL) STEM Achievers program would benefit you:*

About Your Parent/Guardian

Parent/Guardian Name: *

First Name*

Last Name*

Parent/Guardian Email Address:*

Parent Phone:*

Does the student applicant live with you?

Yes No

If the student's home address is the same as yours, choose "Yes"

Parent/Guardian's Current Address:*

Address Line 1

Address Line 2

City

State

ZIP Code

School Information

Name of Your Middle School*

School Web Address:

Optional

School Phone:*

School Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Name of STEM Teacher (for referral):*

First Name*

Last Name*

STEM Teacher Email:*

School Principal's Name:*

First Name*

Last Name*

Principal's Email Address:*