Samsung Austin Semiconductor STEM Academy Experience Request Form

We are looking forward to welcoming you and your students to Samsung Austin Semiconductor STEM Academy. If you are interested in taking part in any of our STEM Academy Experiences, please fill out the following form so that we can work through scheduling and processing your request. In order to effectively organize and schedule your request, please submit your request at least 6 weeks in advance. Please reach out to Jennifer Sabrsula (j.sabrsula@samsung.com) if you have any questions.

Please remember to fill out a form for each experience you are requesting.

Please note, that each request will go under a review and approval process. We will be in touch throughout the review and approval process.

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* Name of Requestor

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* Name of Requesting Public School District

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* Name of Requesting Campus

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* Email Address of Requestor

Email Address

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* Phone Number of Requestor

Phone Number

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* STEM Academy Experience (please choose from the following)

Tour of Samsung Austin Semiconductor's Observation Deck + Time with Subject Matter Experts (engineers, technicians, etc.) ONLY FOR GRADES 9 and above

Samsung Austin Semiconductor to attend an event at your campus (orientations, career fair, other campus event)

Samsung Austin Semiconductor to visit with a class at your campus (CTE classroom, grade level presentations, etc.)

Other (please specify)

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* Date (please enter date you would like to schedule this STEM experience) In order to effectively organize and schedule your request, please submit your request at least 6 weeks in advance of the date you are choosing.

Please note, that all tours scheduled at Samsung Austin Semiconductor will be restricted to available Mondays, Tuesdays, or Thursdays of each week. All requested dates are not confirmed until you have heard back from Samsung Austin Semiconductor about the confirmation of your requested date and time.

Requested Date

Date

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* Requested Time

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* Grade Level of Participants (check all that apply)

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

Other (please specify)

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* Would you permit photos/videos to be taken by Samsung Austin Semiconductor during your STEM Experience?

Yes

Other (please specify)

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* In order to plan an optimal STEM experience for you and your students, please provide us a brief description for what you are seeking to gain from this STEM experience with Samsung Austin Semiconductor.

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* If you are a school district requesting this experience, please provide us with a list of any Idustry Based Certifications that you offer at your campus or feeder campuses.

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