Student Name: *

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Do you know or are affiliated with an employee(s) of Science Park Research Division? Yes No

If YES, name of employee(s):

Science Subjects You've Taken: Biology Chemistry Health Physics Physiology Science, Earth Science, General

Your Average Science Subject(s) Grade: A+ A A- B+ B B- C+ C C- Other

Relevant laboratory work experience (if applicable)

Why do you want to participate in the Summer High School Research Program? Additionally, please list your personal internship objectives and describe how these objectives will contribute to the achievement of your career goals.