CAP Application

CAP APPLICATION FORM

* denotes a required field

First Name*:


Last Name*:


Email*:


Phone number*:

Mailing Address

Street*:


City*:


State*:


School*:


Grade*:

Referral from a teacher or school administrator is required to participate in this program. Please indicate the name and contact information of the person who referred you.

Teacher/Adminstrator Full Name*:


Teacher/Administrator Email*:


How did you hear about this program?
Choose an OptionTeacherSchool Career ResourcesS2S StaffS2S CommunicationsSocial MediaOther

Have you previously participated in an S2S program?
YesNo

If yes, please indicate which program:


Which CAP offerings are you most interested in? * (Select all that apply)
Career FairsCertification ProgramsEmployment OpportunitiesInternshipsJob ShadowingMentoringPost-secondary EducationSkill-based Employment TrainingWorkplace Tours
Which of the following STEM industries are you currently most interested in?* (Select all that apply)
Allied Health ProfessionsBiotech & PharmaceuticalsEngineeringEnvironmental SciencesHealthcare Product DevelopmentOther

Briefly explain why you are interested in participating in the CAP*:

Parent/Guardian Contact 1

At least one Parent/Guardian info is required for individuals under 18.
First Name*:


Last Name*:


Email*:


Phone number*:


Relationship*:

Parent/Guardian Contact 2

First Name:


Last Name:


Email:


Phone number:


Relationship:

Emergency Contact

First Name*:


Last Name*:


Email*:


Phone number*:


Relationship*:

*By submitting this application, I approve of being contacted by email by S2S regarding program notifications and updates.

Questions? Email us at cap@students2science.org