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Be sure to have an electronic copy of a recent report card available to upload to this application before you start.

Students will be accepted on a first-come, first-served basis. We will accept no more than 24 students in each session.

Programs that don't meet enrollment requirements will be cancelled 1 week prior.

Fee is $65 PER SESSION. PLEASE MAIL A SEPARATE CHECK FOR EACH SESSION. Checks should be made payable to the “Research Foundation of SUNY” and sent to the following address:

Institute for STEM Education

092 Life Sciences Building

Stony Brook University

Stony Brook, NY 11794-5233

Student's Name

First Name

Last Name

Phone Number

Parent's Name

Parent's Email address

Check off which program(s) your child will participate in:

Monday, November 11- All about Chemical Reactions
Wednesday, January 29- All about Cells!
Thursday, February 20 - All about Matter!
Thursday, April 17 - All about Motion!

Gender

Male
Female

Age

Grade

5th
6th
7th

School

School District

Please provide any pertinent medical information, including allergies.

Emergency Contact information (name and phone number):

I give permission to Stony Brook University to take photographs of my child,

enrolled in the Holiday Science Camp. I understand that these photographs may be used in local or national media, as well as University brochures and other promotional material, including electronic media such as the Internet, for the express purpose of promoting Stony Brook University and its programs.

Parent's name below indicates your permission.

Attach a recent report card here. This is used to verify the grade level of the student. This can be a download from a parent portal.

Attach a copy of your child's IEP, if applicable.