GESTEM Registration Form 2012

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GESTEM Registration Form 2012 Powered By Docstoc
					                2012 Girls Exploring Science, Technology, Engineering and Math Event
            April 20, 2012, 8:00am - 1:30pm at the Colorado Convention Center, Denver, CO                                                                                                Workshops
                                                                                                                                                                                         1 Animal Crossings                                      6th   Black//African American
Complete registration online starting March 16, 2012 at 8am. Register online via http://www.swe-rms.org, click GESTEM button.                                                            2 Astrobiology: The Search for Life                     7th   Native American
                                                                                                                                                                                         3 Discovering Dinosaurs                                       White/Caucasian
Instructions:                                                                                                                                                                            4 Doggy DNA - A Recipe for Traits                             Hispanic
1. Please use this form to enter in all student information. This form must be complete and uploaded on the registration form to complete registration.                                  5 Shedding Light on Blood                                     Asian/ South Pacific Islands
2. For each student participating, please enter their name, grade, birth month and year, ethnic origin (needed for grants), and if the student has a disability or food alergy (please
                                                                                                                                                                                         6 Biomedical Engineering and Lip gloss
note below if yes).                                                                                                                                                                                                                                    Other
3. Schools are limited to 45 students, 6th and 7th grade girls only.                                                                                                                     7 Heart Smart
4. We will try our best to accommodate student's workshop requests, however due to space limitations in each workshop, we cannot guarantee which workshop the student will
                                                                                                                                                                                         8 Separating Blood to Save Lives
be assigned. Students should indicate their workshop interest independently. School groups will be separated into pods with a volunteer guide.
5. In addition to the information below you will need the School name, address, phone number and district. For each chaperone, you will need their name, email address and cell
                                                                                                                                                                                         9 Intro to Game Development
phone number (changes can be emailed before the event).



                                                                                                                                                                                         10 Get Energized at CSU


                                                                                                                                                                                         11 Take Charge! Student Energy Education and Action
          SCHOOL NAME:
STUDENT INFORMATION (PERSONAL INFORMATION):                                                                                                                                              12 Energy Efficiency - Are YOU in "The Know"?
                                                                                                                                                                     Student has a
                                                                                                                                                                        physical
                                                                                   1st              2nd                 3rd                                           disability or      13 Do you have what it takes?
                                                                               Workshop          Workshop           Workshop            Ethnic        Birthdate       food alergy
           First Name                 Last Name                    Grade       Preference        Preference         Preference          Origin          (m/y)          (Yes / No)
                                                                                                                                                                                         14 Math Moves You
       1                                                              7th

                                                                                                                                                                                         15 The Game of Life
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                                                                                                                                                                                         16 Active Space Science
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                                                                                                                                                                                         17 Art and Science
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                                                                                                                                                                                         18 Ready, Step, Launch!
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                                                                                                                                                                                         19 Defending and Protecting the USA
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                                                                                                                                                                                         20 Gum Drop Bridges
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                                                                                                                                                                                         21 The Engineering Behind Roads
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                                                                                                                                                                                         22 Tackle the Tower
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                                                                                                                                                                                         23 Eggstraordinary Lander
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                                                                                                                                                                                         24 Bouncing Laser Light
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                                                                                                                                                                                         25 Line Chaserz Robotic Car
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                                                                                                                                                                                         26 Hovercraft
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                                                                                                                                                                                         27 Getting to Know Your Water
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                                                                                                                                                                                         28 Water Jeopardy
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                                                                                                                                                                                         29 Now You See It, Now you Don't: The Power of Fluids
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                                                                                                                                                                                         30 Weather in a Bottle
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                                                                                                                             11 Take Charge! Student Energy Education and Action
          SCHOOL NAME:
STUDENT INFORMATION (PERSONAL INFORMATION):                                                                                  12 Energy Efficiency - Are YOU in "The Know"?
                                                                                                            Student has a
                                                                                                               physical
                                                    1st         2nd           3rd                            disability or   13 Do you have what it takes?
                                                Workshop     Workshop     Workshop     Ethnic   Birthdate    food alergy
        First Name     Last Name        Grade   Preference   Preference   Preference   Origin     (m/y)       (Yes / No)

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