2015 Biosphere 2 Science Academy Application Form

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* 1. Student Applicant Information

Last Name:

First Name:

Age:

Date of Birth:

Gender:

Nickname (or what student prefers to be called):

SCHOOL NAME, City and State (Spring 2015):

SCHOOL NAME, City and State (Fall 2015):

Grade in Fall 2015:

Home Address:

City:

State:

Zipcode:

Home phone:

Email Address:

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* 2. Did you attend the 2014 Biosphere 2 Science Academy program?

Yes, the middle school week, June 6 - 12, 2014

Yes, the high school week, June 13 - 19, 2014

No, I did not attend last year

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* 3. PARENT / GUARDIAN INFORMATION

Parent/Guardian 1: Last Name

First Name:

Primary Phone Number:

Secondary Phone Number:

Email Address:

Parent/Guardian 2: Last Name

First Name:

Primary Phone Number:

Secondary Phone Number:

Email Address:

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* 4. BIOSPHERE 2 SCIENCE ACADEMY WEEK SELECTION (check one)

July 12-18, 2015 (for rising 7-9th grade students)

July 19-25, 2015 (for rising 9-12th grade students)

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* 5. DEPOSIT INFORMATION

If your student is selected to participate in the 2015 Science Academy, a non-refundable deposit of $250.00 will be required along with the completion of a registration packet.

Payment information:
Credit Card: Contact Nancy Boklund at (520) 838-6192
Checks: payable to U of A, Biosphere 2 (please write student's name and "Science Academy" on memo line). Mail To: Biosphere 2 Science Academy, Attn: Nancy Boklund, P.O. Box 8746 Tucson, AZ 85738

I acknowledge that a non-refundable deposit of $250.00 will be required should my student be selected.

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* 6. UPON ARRIVAL, STUDENTS WILL RECEIVE
a Biosphere 2 t-shirt, hat, water bottle, and notebook.
Please indicate the shirt size needed (in men's sizes).

Small

Medium

Large

X-Large

2X-Large

Other Size (please specify)

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* 7. DROP-OFF and PICK-UP AUTHORIZATION

Please only provide names of those, other than parents/guardians listed above, who are authorized to pick up your student. IDENTIFICATION WILL BE REQUIRED.

Authorized Person 1: (first and last name, phone number)

Authorized Person 2: (first and last name, phone number)

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* 8. CHECK-IN and CHECK-OUT:
Sunday Student Check-in: Noon - 3PM
Saturday Student Symposium: 10AM, FAMILIES ARE WELCOME!
Saturday Student Check-out: Noon - 2PM

Please indicate if you would like Biosphere 2 to provide student transportation TO and/or FROM the Tucson International Airport ($50 each way per student). We will follow up regarding details.

No, thank you, we will not need transportation TO and/or FROM the Tucson International Airport

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* 9. Essay question: Please describe briefly your expectations of the Biosphere 2 Science Academy, what you hope to gain from the experience, and why you should be selected. (350 words or less)

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* 10. Teacher Recommendation: Please ask a current or recent teacher to provide a recommendation for the applying student. The recommendation should be sent via email to Nancy Boklund at <nboklund@email.arizona.edu>.

The recommendation should include, but not be limited to, the following information:

In the email subject line, please type: "Teacher Recommendation for (name of applying student), 2015 Biosphere 2 Science Academy"

Why the student would be a good candidate to attend the week-long 2015 Biosphere 2 Science Academy (e.g. academic capabilities, interest in science, social skills, maturity, etc.)

*Teacher contact information

I have asked, or will ask, a teacher to submit a recommendation on my behalf.

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* 11. Contact information for recommending teacher

Teacher's Name:

Teacher's email address:

Teacher's phone number:

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* 12. How did you hear about the Biosphere 2 Science Academy?

Biosphere 2 Website

Social Media

School or Teacher

Biosphere 2 Visit

Print Media

Other (please specify)

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* 13. ADDITIONAL INFORMATION THAT YOU MAY WANT TO SHARE:

For additional details about the 2015 Biosphere 2 Science Academy, including sample schedules, faculty biographies, and pricing information, please see: http://b2science.org/outreach/sciacademy

Your voluntary submission of this form electronically serves as your signature in place of a traditionally signed form. By registering, submitting payment, and completing the required forms online you are authorizing that the information is correct and you are in agreement with the terms and conditions of this Program.

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* 1. Student Applicant Information

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* 2. Did you attend the 2014 Biosphere 2 Science Academy program?

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* 3. PARENT / GUARDIAN INFORMATION

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* 4. BIOSPHERE 2 SCIENCE ACADEMY WEEK SELECTION (check one)

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* 6. UPON ARRIVAL, STUDENTS WILL RECEIVEa Biosphere 2 t-shirt, hat, water bottle, and notebook.Please indicate the shirt size needed (in men's sizes).

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* 7. DROP-OFF and PICK-UP AUTHORIZATIONPlease only provide names of those, other than parents/guardians listed above, who are authorized to pick up your student. IDENTIFICATION WILL BE REQUIRED.

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* 8. CHECK-IN and CHECK-OUT:Sunday Student Check-in: Noon - 3PMSaturday Student Symposium: 10AM, FAMILIES ARE WELCOME!Saturday Student Check-out: Noon - 2PM

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* 9. Essay question: Please describe briefly your expectations of the Biosphere 2 Science Academy, what you hope to gain from the experience, and why you should be selected. (350 words or less)

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* 11. Contact information for recommending teacher

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* 12. How did you hear about the Biosphere 2 Science Academy?

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* 13. ADDITIONAL INFORMATION THAT YOU MAY WANT TO SHARE:

* 6. UPON ARRIVAL, STUDENTS WILL RECEIVE
a Biosphere 2 t-shirt, hat, water bottle, and notebook.
Please indicate the shirt size needed (in men's sizes).

* 7. DROP-OFF and PICK-UP AUTHORIZATION

Please only provide names of those, other than parents/guardians listed above, who are authorized to pick up your student. IDENTIFICATION WILL BE REQUIRED.

* 8. CHECK-IN and CHECK-OUT:
Sunday Student Check-in: Noon - 3PM
Saturday Student Symposium: 10AM, FAMILIES ARE WELCOME!
Saturday Student Check-out: Noon - 2PM