STEP Application

Student Information

First Name

Preferred Name

Last Name

Sex Assigned at Birth/Legal Sex

Gender Identity

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Student Personal Email Address (not school address)

Student Cell Phone (or home phone)

Eligibility

Is student eligible for free/reduced lunch?

Yes

No

Family Information

Parent/Guardian #1

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email Address

Would you like to join the STEP Parent Leaders in supporting and planning for the program?

Yes

Not at this time

Parent/Guardian #2 (Optional)

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email

School Information

High School/Middle School

High School CEEB [HIDDEN]

School Counselor

Current Grade Level

Current GPA

What year do you expect to graduate?

Student Agreement

I, (Print Student's Name)

agree to participate in the Science and Technology Entry Program (STEP) at Farmingdale State College. As a participant, I will attend activities as scheduled, and I will be on time for all activities. I agree to follow the direction of program staff and instructors and to behave in a manner that is safe for me and those around me. I understand that my signature on this document constitutes an agreement between me and SUNY Farmingdale.

Student's Signature (print first and last name)

Today's Date

STEP Application

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