TRIAD BIOSUMMER 2008
Application
To the Applicant: Your science teacher has given
the Triad BioSummer selection committee your name as a good candidate for this exciting program.
Please complete this application, including parent signature. Have your science teacher complete the recommendation form, return it to you in a
sealed envelope, and attach it to the rest of the application and mail to:
Andy Clifton, Program Coordinator
5215 Meadowlark Glen Lane
Winston-Salem, NC 27106
APPLICATION MUST BE RECEIVED BY MARCH 15, 2008
Interviews may be held in mid-March and students will be notified of final selection
by April 7, 2008
Triad BioSummer 2008 will be held June 16 – 20 and June 23 - 27
Triad
BioSummer is a hands-on program in biotechnology and entrepreneurship for rising 11th, and 12th grade
students from Winston-Salem and the surrounding area. It incorporates science,
business, and fun! Under the guidance of high school and university faculty experienced
in biotechnology, students participate in hands-on lab activities, meet renowned scientists, and visit local biotechnology
companies. Guest speakers bring real world experiences to the students in areas
that include stem cell research, pharmaceutical development, forensics, and bioethics. The students will also work in teams
to develop a Power Point presentation to be presented at the June 27th “graduation” ceremony.
This is a two - week
program held during the day on the campus of Wake Forest University. Parents
are responsible for transportation to and from the program. During the second week, participants will stay on campus for 3
nights (June 24, 25 and 26th) in dormitories under appropriate supervision in order to finalize their presentations. A middle school version of this program will be running concurrently at a different
location, and these students will join us for selected activities during the second week.
Thanks to our sponsors, there is
no charge to the students to attend this program. Out of respect for the generosity
of these sponsors, and to businesses and presenters involved in the program, students will be expected to make a total
commitment to the program during these two weeks. If you are involved in
other summer activities and will be unable to attend ALL aspects of the program, please do not apply.
Statement of Commitment
If selected to attend the Triad BioSummer
2008 program I will attend all sessions, and behave in a responsible and respectful manner, thus representing the program
in a positive way. I understand that local scientists and businesses are taking
their valuable time to accommodate our visits, and I understand that the instructors have spent many hours preparing labs
and activities so that learning can be an enjoyable experience. Any actions not reflective of this attitude may result in
immediate dismissal from the program.
Student Signature ______________________________ Date________________________
Student Applicants: On
a separate sheet of paper, please answer the following questions and attach to the application.
- How would you define biotechnology?
- Briefly describe why you want to participate in Triad BioSummer 2008
and what you hope to learn.
- What is your favorite school subject? Why do you like it?
- What do you like to do with your free time?
Questions regarding the program may be directed to the Program Coordinator, Andy Clifton.
E-mail: wclifton@triad.rr.com Phone: (336) 978-3941
Student name and Contact Information:
Student Name: ______________________________ Gender: __________
Parent/Guardian name(s): _________________________________________
Home address: __________________________________________________
Work phone(s): ____________________________
Home phone: ____________________________
Student email address: _________________________
Parent email address: __________________________
School Information
Student’s
School: _____________________________
Students Current Grade Level: __________________
Science Teacher: _____________________________
School Phone: ___________________
As a parent / guardian, I understand the importance of encouraging my child to act responsibly,
and I will do my part by having my student at the assigned locations on time and will arrange for pick up at the given time.
________________________________________________________________________
Parent(s) / Guardian Signature
Date
Photo Release Permission
We are interested in publishing pictures of the students in various publications and on sponsor
web sites (e.g. Winston-Salem Chamber of Commerce, Wake Forest University, and corporate sponsors, etc.) Student last names
will NOT be used with the pictures.
I/we give permission to Triad BioSummer 2008 for promotional use of photographs of:
______________________________________________________
Student Name (PLEASE PRINT)
______________________________________________________
Parent/Guardian signature
____________________
Date
Recommendation Form
______________________(student)
is interested in participating in a summer biotechnology program, Triad BioSummer 2008 which involves hands-on lab activities,
visits to local biotechnology companies and meeting scientists and business leaders.
The goal is to encourage students of all cultural backgrounds to explore career options in the field of biotechnology. We are looking for highly motivated, mature students who can work independently in
a lab setting, and who may not otherwise have the chance to enhance their interest in science.
Please complete this form and return it to the
student in a sealed envelope with your signature across the flap of the envelope.
Teacher name: ____________________________________
Phone: _____________________
School: ___________________________________
Student’s current
letter grade in science: __________
Please rank the student
in the following areas:
Excellent
Good
Fair
Poor
Leadership
4
3
2
1
Attitude
4
3
2
1
Cooperation
4
3
2
1
Punctuality
4
3
2
1
Ability to follow
Instructions
4
3
2
1
Attentiveness
4
3
2
1
Respectfulness
4
3
2
1
Overall performance 4
3
2
1
Additional comments:
Signature: ______________________________
Date: _______________________
