Exit this survey Boys Build IT! Application 2019 Boys Build IT! Application 2019 June 24th -28th at Liberty High School from 9am - 12pm Question Title * 1. Please fill out the following. Name: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Email Address: * Phone Number: * Question Title * 2. Please fill out the following information of your parent or guardian. We will email parents additional information for completing medical and photo waivers and camp payment. Name: Email Address: Phone Number: Question Title * 3. Please provide an emergency contact other than the one you listed before. Name: Phone Number: Question Title * 4. What grade will you be in this coming year? 5 6 7 Other (please specify) Question Title * 5. What school will you be attending this coming year? Question Title * 6. Rate your knowledge or participation from 0 (I have never heard of it) to 5 (I am the master): 0 1 2 3 4 5 FLL Team FLL Team 0 FLL Team 1 FLL Team 2 FLL Team 3 FLL Team 4 FLL Team 5 FTC Team FTC Team 0 FTC Team 1 FTC Team 2 FTC Team 3 FTC Team 4 FTC Team 5 FRC Team FRC Team 0 FRC Team 1 FRC Team 2 FRC Team 3 FRC Team 4 FRC Team 5 OGPC OGPC 0 OGPC 1 OGPC 2 OGPC 3 OGPC 4 OGPC 5 Science Bowl Science Bowl 0 Science Bowl 1 Science Bowl 2 Science Bowl 3 Science Bowl 4 Science Bowl 5 Soldering Soldering 0 Soldering 1 Soldering 2 Soldering 3 Soldering 4 Soldering 5 CAD modeling CAD modeling 0 CAD modeling 1 CAD modeling 2 CAD modeling 3 CAD modeling 4 CAD modeling 5 Autodesk Autodesk 0 Autodesk 1 Autodesk 2 Autodesk 3 Autodesk 4 Autodesk 5 EV3 EV3 0 EV3 1 EV3 2 EV3 3 EV3 4 EV3 5 HTML HTML 0 HTML 1 HTML 2 HTML 3 HTML 4 HTML 5 Java Java 0 Java 1 Java 2 Java 3 Java 4 Java 5 Arduino Arduino 0 Arduino 1 Arduino 2 Arduino 3 Arduino 4 Arduino 5 Binary Binary 0 Binary 1 Binary 2 Binary 3 Binary 4 Binary 5 Question Title * 7. Why do you want to go to this camp?from 0 being (does not apply to me) to 5 (most definitely) 0 1 2 3 4 5 Attending with a friend Attending with a friend 0 Attending with a friend 1 Attending with a friend 2 Attending with a friend 3 Attending with a friend 4 Attending with a friend 5 Have Fun! Have Fun! 0 Have Fun! 1 Have Fun! 2 Have Fun! 3 Have Fun! 4 Have Fun! 5 Learn more about Technology Learn more about Technology 0 Learn more about Technology 1 Learn more about Technology 2 Learn more about Technology 3 Learn more about Technology 4 Learn more about Technology 5 Learn more about Robotics Learn more about Robotics 0 Learn more about Robotics 1 Learn more about Robotics 2 Learn more about Robotics 3 Learn more about Robotics 4 Learn more about Robotics 5 Learn more about Sciences Learn more about Sciences 0 Learn more about Sciences 1 Learn more about Sciences 2 Learn more about Sciences 3 Learn more about Sciences 4 Learn more about Sciences 5 Gain experiences in Science Technology Engineering and Math Gain experiences in Science Technology Engineering and Math 0 Gain experiences in Science Technology Engineering and Math 1 Gain experiences in Science Technology Engineering and Math 2 Gain experiences in Science Technology Engineering and Math 3 Gain experiences in Science Technology Engineering and Math 4 Gain experiences in Science Technology Engineering and Math 5 Discover engineering in a fun environment Discover engineering in a fun environment 0 Discover engineering in a fun environment 1 Discover engineering in a fun environment 2 Discover engineering in a fun environment 3 Discover engineering in a fun environment 4 Discover engineering in a fun environment 5 Other (please specify): Question Title * 8. What do you hope to gain from this experience?from 0 (being does not apply to me) to 5 (most definitely) 0 1 2 3 4 5 Have Fun! Have Fun! 0 Have Fun! 1 Have Fun! 2 Have Fun! 3 Have Fun! 4 Have Fun! 5 Positive experiences with technology Positive experiences with technology 0 Positive experiences with technology 1 Positive experiences with technology 2 Positive experiences with technology 3 Positive experiences with technology 4 Positive experiences with technology 5 Technical skills Technical skills 0 Technical skills 1 Technical skills 2 Technical skills 3 Technical skills 4 Technical skills 5 Meet professionals in technology and engineering Meet professionals in technology and engineering 0 Meet professionals in technology and engineering 1 Meet professionals in technology and engineering 2 Meet professionals in technology and engineering 3 Meet professionals in technology and engineering 4 Meet professionals in technology and engineering 5 Meet others interested in science technology engineering or math Meet others interested in science technology engineering or math 0 Meet others interested in science technology engineering or math 1 Meet others interested in science technology engineering or math 2 Meet others interested in science technology engineering or math 3 Meet others interested in science technology engineering or math 4 Meet others interested in science technology engineering or math 5 Other (please specify) Question Title * 9. How do YOU think engineering is important in everyday life?from 0 (being not at all) to 5 (most definitely) 0 1 2 3 4 5 Helps solve everyday problems Helps solve everyday problems 0 Helps solve everyday problems 1 Helps solve everyday problems 2 Helps solve everyday problems 3 Helps solve everyday problems 4 Helps solve everyday problems 5 Improves communication Improves communication 0 Improves communication 1 Improves communication 2 Improves communication 3 Improves communication 4 Improves communication 5 Makes our lives better Makes our lives better 0 Makes our lives better 1 Makes our lives better 2 Makes our lives better 3 Makes our lives better 4 Makes our lives better 5 Helps us to use resources more wisely Helps us to use resources more wisely 0 Helps us to use resources more wisely 1 Helps us to use resources more wisely 2 Helps us to use resources more wisely 3 Helps us to use resources more wisely 4 Helps us to use resources more wisely 5 Please share your favorite role model in STEM. Question Title * 10. Will you be able to attend the camp for the full session? Yes No Other (please specify) Done