Online Survey Software | Qualtrics Survey Solutions

EASE Summer Immersion Challenge Application

Please note the following eligibility criteria:

1) You must be a student in Omaha Public Schools or Hampton City Schools and surrounding area.

2) You must be an African American student.

3) You must be a rising 10th grader (currently in 9th grade).

Last Name:

First Name:

Preferred Name (if applicable):

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Email Address:

Phone Number:

Date of Birth:

Pronouns:

They/Them/Theirs
She/Her/Hers
He/Him/His
Let me type:

Parent/Guardian Name:

Parent/Guardian Phone Number:

School Name:

School District:

Hampton City Schools and Surrounding Area
Omaha Public Schools
Other

Current grade / year:

8th Grade (Rising 9th grader)
9th Grade (Rising 10th grader, Freshman)
10th Grade (Rising 11th grader, Sophomore)

Will you have access to a computer and internet during the program (June 17 - June 28, 2024)?

Yes
No
Unsure

Please enter your most recent GPA:

Please upload a letter of recommendation from a non-parent mentor or teacher.

Please upload a personal statement indicating your interest in science, technology, engineering, and mathematics (STEM). This personal statement should be less than 300 words.