Energetic Einsteins Scholarship Application Summer 2013

1. Energetic Einsteins Scholarship for Gifted Students

Dear Gifted Student and Parents/Guardians,

Thank you for your interest in our Scholarship Program for Gifted Students. Please take a moment to answer all of the questions on this application form. Students under the age of 18 must provide parental information where it is requested on the application and must obtain parental permission.
Some questions must be answered by the student in their own words. These are clearly marked.
The questions on the second page will be used to determine financial need. These questions must be answered by an adult or an individual over 18 years of age. These answers will be kept confidential.
We accept donations for scholarships from individuals and organizations. The number and dollar amount of the scholarships awarded will depend on the donations and grants that are obtained for this effort.

I look forward to working with you,
Dr. Demetrikopoulos

Melissa K. Demetrikopoulos, Ph.D.
Director of Scientific Communications
Chair, Division of Program Development and Assessment
Energetic Einsteins
GiftedInfo@BioPhi.org

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* 1. For the following questions please provide the information requested. Please provide the student's permanent address.

Student Name: *

Parent/Guardian:

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Country: *

Email Address: *

Phone Number: *

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* 2. We are currently taking scholarship applications for summer 2013. Which session(s) are you registering for.

Brains and Behavior Program July 8-12

Wizard Camp for Gifted Muggles August 5-9

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* 3. Please answer the following question with the Month Day and Year.

Date of Student's birth

Date

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* 4. Gender

Male

Female

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* 5. Please indicate type of gifted program that you participate(ed) in during the school year (mark as many as apply).

Grade Skipping

Course Acceleration (ie 3rd grader in with 4th graders for one or more subjects)

Full-time gifted program

Pull out part-time gifted program

Other (please specify)

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* 6. Current Grade Level (2012-2013 school year)

College Freshman

College Sophomore

College Junior

College Senior

Other College

Please note any classes taken out of your current grade level

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* 7. Please Indicate your GPA for THE MOST RECENT 3 YEARS. Include this current year if you have gotten any report cards thus far. Please convert all grades to a 4 point scale. Thus, all A's are worth 4 points regardless of AP or other status. Also, for schools that do not give grades in the early years, please convert the grades such that the highest option is a 4.

	3.5-4.0	3.0-3.49	2.5-2.99	2.0-2.49	1.5-1.99	1.0-1.49	0.0-0.99
K	K 3.5-4.0	K 3.0-3.49	K 2.5-2.99	K 2.0-2.49	K 1.5-1.99	K 1.0-1.49	K 0.0-0.99
1	1 3.5-4.0	1 3.0-3.49	1 2.5-2.99	1 2.0-2.49	1 1.5-1.99	1 1.0-1.49	1 0.0-0.99
2	2 3.5-4.0	2 3.0-3.49	2 2.5-2.99	2 2.0-2.49	2 1.5-1.99	2 1.0-1.49	2 0.0-0.99
3	3 3.5-4.0	3 3.0-3.49	3 2.5-2.99	3 2.0-2.49	3 1.5-1.99	3 1.0-1.49	3 0.0-0.99
4	4 3.5-4.0	4 3.0-3.49	4 2.5-2.99	4 2.0-2.49	4 1.5-1.99	4 1.0-1.49	4 0.0-0.99
5	5 3.5-4.0	5 3.0-3.49	5 2.5-2.99	5 2.0-2.49	5 1.5-1.99	5 1.0-1.49	5 0.0-0.99
6	6 3.5-4.0	6 3.0-3.49	6 2.5-2.99	6 2.0-2.49	6 1.5-1.99	6 1.0-1.49	6 0.0-0.99
7	7 3.5-4.0	7 3.0-3.49	7 2.5-2.99	7 2.0-2.49	7 1.5-1.99	7 1.0-1.49	7 0.0-0.99
8	8 3.5-4.0	8 3.0-3.49	8 2.5-2.99	8 2.0-2.49	8 1.5-1.99	8 1.0-1.49	8 0.0-0.99
9	9 3.5-4.0	9 3.0-3.49	9 2.5-2.99	9 2.0-2.49	9 1.5-1.99	9 1.0-1.49	9 0.0-0.99
10	10 3.5-4.0	10 3.0-3.49	10 2.5-2.99	10 2.0-2.49	10 1.5-1.99	10 1.0-1.49	10 0.0-0.99
11	11 3.5-4.0	11 3.0-3.49	11 2.5-2.99	11 2.0-2.49	11 1.5-1.99	11 1.0-1.49	11 0.0-0.99
12	12 3.5-4.0	12 3.0-3.49	12 2.5-2.99	12 2.0-2.49	12 1.5-1.99	12 1.0-1.49	12 0.0-0.99
College Freshman	College Freshman 3.5-4.0	College Freshman 3.0-3.49	College Freshman 2.5-2.99	College Freshman 2.0-2.49	College Freshman 1.5-1.99	College Freshman 1.0-1.49	College Freshman 0.0-0.99
College Sophomore	College Sophomore 3.5-4.0	College Sophomore 3.0-3.49	College Sophomore 2.5-2.99	College Sophomore 2.0-2.49	College Sophomore 1.5-1.99	College Sophomore 1.0-1.49	College Sophomore 0.0-0.99
College Junior	College Junior 3.5-4.0	College Junior 3.0-3.49	College Junior 2.5-2.99	College Junior 2.0-2.49	College Junior 1.5-1.99	College Junior 1.0-1.49	College Junior 0.0-0.99
College Senior	College Senior 3.5-4.0	College Senior 3.0-3.49	College Senior 2.5-2.99	College Senior 2.0-2.49	College Senior 1.5-1.99	College Senior 1.0-1.49	College Senior 0.0-0.99
Other College	Other College 3.5-4.0	Other College 3.0-3.49	Other College 2.5-2.99	Other College 2.0-2.49	Other College 1.5-1.99	Other College 1.0-1.49	Other College 0.0-0.99

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* 8. Please mark all of the courses below that you took in middle school (Grades 5-8). (Please skip question for students under Grade 5.)

	Honors/Advanced	Pre-AP	AP	IB
Biology	Biology Honors/Advanced	Biology Pre-AP	Biology AP	Biology IB
Chemistry	Chemistry Honors/Advanced	Chemistry Pre-AP	Chemistry AP	Chemistry IB
Physics	Physics Honors/Advanced	Physics Pre-AP	Physics AP	Physics IB
Psychology	Psychology Honors/Advanced	Psychology Pre-AP	Psychology AP	Psychology IB
Algebra I	Algebra I Honors/Advanced	Algebra I Pre-AP	Algebra I AP	Algebra I IB
Geometry	Geometry Honors/Advanced	Geometry Pre-AP	Geometry AP	Geometry IB
Algebra II	Algebra II Honors/Advanced	Algebra II Pre-AP	Algebra II AP	Algebra II IB
Pre-Calculus	Pre-Calculus Honors/Advanced	Pre-Calculus Pre-AP	Pre-Calculus AP	Pre-Calculus IB
Calculus	Calculus Honors/Advanced	Calculus Pre-AP	Calculus AP	Calculus IB
Statistics	Statistics Honors/Advanced	Statistics Pre-AP	Statistics AP	Statistics IB

Other Honors/Advanced, Pre-AP, AP, or IB courses (please specify)

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* 9. Please mark all of the courses below that you took in high school. (Please skip question for students under Grade 9.)

	Honors	AP	IB
Biology	Biology Honors	Biology AP	Biology IB
Chemistry	Chemistry Honors	Chemistry AP	Chemistry IB
Physics	Physics Honors	Physics AP	Physics IB
Psychology	Psychology Honors	Psychology AP	Psychology IB
Algebra I	Algebra I Honors	Algebra I AP	Algebra I IB
Geometry	Geometry Honors	Geometry AP	Geometry IB
Algebra II	Algebra II Honors	Algebra II AP	Algebra II IB
Pre-Calculus	Pre-Calculus Honors	Pre-Calculus AP	Pre-Calculus IB
Calculus	Calculus Honors	Calculus AP	Calculus IB
Statistics	Statistics Honors	Statistics AP	Statistics IB

Other Honors, AP or IB courses (please specify)

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* 10. Please indicate any academic competitions that you have been involved with in the past 3 school years. Please mark Participation for any event in which you did not earn first place even if you received another award. Please try to choose the closest category to the competition in which you participated even if it is not an exact match.

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* 11. Please list your relevant extracurricular activities. You may ALSO send a copy of your full cv or resume if you have one to GiftedInfo@BioPhi.org. Please notate here if you are doing so.

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* 12. In 3-5 sentences, please tell us what you hope to gain by participating in the Energetic Einstein Program that you are seeking a Scholarship for. (This question needs to be answered by the student in their own words.)

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* 13. In 3-5 sentences, please tell us what you think you can contribute during the Energetic Einstein Program that you are seeking a Scholarship for. (This question needs to be answered by the student in their own words.)

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* 14. Is there any other important information that we should know about your achievements or academic potential? (Parents/Guardians may send testing information to GiftedInfo@BioPhi.org if they would like this to be considered. Please notate here if you are doing so.)

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* 15. Please provide the following information. Please do not leave the questions blank and respond with none if there is no other response.

Mother/Guardian-A name

Mother/Guardian-A email address

Mother/Guardian-A Cell phone

Mother/Guardian-A alternative contact

Father/Guardian-B name

Father/Guardian-B email address

Father/Guardian-B Cell phone

Father/Guardian-B alternative contact

	2012-2013	2011-2012	2010-2011
Science Fair Participation	Science Fair Participation 2012-2013	Science Fair Participation 2011-2012	Science Fair Participation 2010-2011
Science Fair 1st Place	Science Fair 1st Place 2012-2013	Science Fair 1st Place 2011-2012	Science Fair 1st Place 2010-2011
Other Science Competition Participation	Other Science Competition Participation 2012-2013	Other Science Competition Participation 2011-2012	Other Science Competition Participation 2010-2011
Other Science Competition 1st Place	Other Science Competition 1st Place 2012-2013	Other Science Competition 1st Place 2011-2012	Other Science Competition 1st Place 2010-2011
Engineering or Robotics Competition Participation	Engineering or Robotics Competition Participation 2012-2013	Engineering or Robotics Competition Participation 2011-2012	Engineering or Robotics Competition Participation 2010-2011
Engineering or Robotics Competition 1st Place	Engineering or Robotics Competition 1st Place 2012-2013	Engineering or Robotics Competition 1st Place 2011-2012	Engineering or Robotics Competition 1st Place 2010-2011
Math Competition Participation	Math Competition Participation 2012-2013	Math Competition Participation 2011-2012	Math Competition Participation 2010-2011
Math Competition 1st Place	Math Competition 1st Place 2012-2013	Math Competition 1st Place 2011-2012	Math Competition 1st Place 2010-2011
Reading Competition Participation	Reading Competition Participation 2012-2013	Reading Competition Participation 2011-2012	Reading Competition Participation 2010-2011
Reading Competition 1st Place	Reading Competition 1st Place 2012-2013	Reading Competition 1st Place 2011-2012	Reading Competition 1st Place 2010-2011
Writing Competition Participation	Writing Competition Participation 2012-2013	Writing Competition Participation 2011-2012	Writing Competition Participation 2010-2011
Writing Competition 1st Place	Writing Competition 1st Place 2012-2013	Writing Competition 1st Place 2011-2012	Writing Competition 1st Place 2010-2011
History Competition Participation	History Competition Participation 2012-2013	History Competition Participation 2011-2012	History Competition Participation 2010-2011
History Competition 1st Place	History Competition 1st Place 2012-2013	History Competition 1st Place 2011-2012	History Competition 1st Place 2010-2011
Social Studies Competition Participation	Social Studies Competition Participation 2012-2013	Social Studies Competition Participation 2011-2012	Social Studies Competition Participation 2010-2011
Social Studies Competition 1st Place	Social Studies Competition 1st Place 2012-2013	Social Studies Competition 1st Place 2011-2012	Social Studies Competition 1st Place 2010-2011
Spelling Competition Participation	Spelling Competition Participation 2012-2013	Spelling Competition Participation 2011-2012	Spelling Competition Participation 2010-2011
Spelling competition 1st Place	Spelling competition 1st Place 2012-2013	Spelling competition 1st Place 2011-2012	Spelling competition 1st Place 2010-2011