Form 3 HiSTEP-High School Scientific Training Enrichment Progra

HISTEP - CONTACT INFORMATION
OMB No. 0925-0299
Expiration Date: 08/31/2016
Respondant Burden
As a participant of the HiSTEP program, the OITE invites you and your parents / guardians to participate
in one of the scheduled orientations. The HiSTEP orientation is designed to distribute and complete
appointment paperwork, become acquainted with OITE staff members, and answer any questions or
concerns. If you and your parents / guardians are unable to participate in an orientation, please contact
the OITE as soon as possible.

STUDENT'S CONTACT INFORMATION
Student's First Name (Given Name):*

Student's Last Name (Family Name):*

Student's Preferred E-mail Address:*
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Student's Phone Number:*
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STUDENT'S RESEARCH INTERESTS
STEM-M Area of Interest:*

Research Interests:*

Short Biography:*

PARENT OR LEGAL GUARDIAN CONTACT INFORMATION
Parent or Legal Guardian First Name (Given Name):*

Parent or Legal Guardian Last Name (Family Name):*

Parent or Legal Guardian E-mail Address:*
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Parent or Legal Guardian Phone Number:*
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Relationship to the Student:*

EVENT PREFERENCES
Orientation Date - First Preference:*

Orientation Date - Second Preference:

Orientation Date - Third Preference:

Do you need an interpreter?:*
Yes

No

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