STEM INSTITUTE

The City College

of
THE CITY UNIVERSITY OF NEW YORK
Convent Avenue and 140th Street, Room T-2M15
New York, NY 10031
THE STEM INSTITUTE

TEL: (212) 650 8172/6190

FAX: (212) 650 8048
E-MAIL:stem@ccny.cuny.edu

STEM Institute 2015 Application

Note: Incomplete applications WILL NOT be reviewed: Application deadline> April 24, 2015

STUDENT INFORMATION

Name: __________________________ _________________________ _______________________

(Last Name)

(First Name)

(Your HS OSI #)

Address: ________________________________________________________ Apt #: _____________

City: ______________________________________ State: ___________ Zip Code: ______________
Social Security #: _____________________ Student Cell Phone #:_____________________________
Students email address: __________________________________________________________
(Please print)

Date of Birth: ________________ Country of Birth: __________________ Language: _____________

City

Ethnicity:

Black Non-Hispanic
Hispanic White Non-Hispanic American Indian
Asian-Pacific Islander Other (Please specify): _____________________________

Citizenship: US Citizen

US Permanent Resident

Other: _____________

Sex: F M

No Yes. If Yes, When: Summer of ___________

Did you attend The STEM Institute before?

PARENT INFORMATION

Parent(s)/Guardians Name: ____________________________________________________________

Home Phone #: _________________________ Work Phone #: ________________________________
Current Grade:

EDUCATION INFORMATION
th Grade: __________ When will Grad. ___________

HS Avg.: __________ Math Avg.: _________ SAT Scores: Math: __________ Verbal: ___________
ACT Score(s): Math _____

Reading: ______ English: ______

Are you eligible for FREE or Reduced Lunch?

Chemistry: ______

Yes or No

Phys:______

Household size? _________

School Name: _______________________________ Counselor Name: _________________________

School Address: ____________________________ City: ___________ State: ______ Zip: _________
Tel: _______________________ Extension: ___________ E-mail:_____________________________
AP Courses Completed: _________________, _______________________, _____________________
(See back)

Please check ONLY ONE group. Each group has two classes.
Are you planning to be absent more than twice? Please check one: Yes or No
Please notice: we HAVE Limited space in each class
A.

1. Calculus I (1 elective HS credit)

MUST check Option 2

or 3

Option 2. Robotics/Engineering Design 10100 (Non-credit)

Option 3. College Critical Writing & Reading (1 elective HS credit) Pre-requisite: Non-ESL
Pre-requisite: Pre-calculus with a grade of 90 from HS or C / better from any college

B.

1. College Pre-Calculus (1 elective HS credit)

MUST check Option 2

or 3

Option 2. General College Physics (1 elective HS credit)

Option 3. General Chemistry (1 elective HS credit)
Pre-requisite: A grade of 90 or better in Algebra 2 or its equivalent

C.

1. Advanced College Algebra (1 elective HS credit) MUST check Option 2

or 3

Option 2. General Chemistry (1 elective HS credit)

Option 3. College Critical Writing & Reading (1 elective HS credit), Pre-requisite: Non-ESL
Pre-requisite: A grade of 90 or better in Algebra I or its equivalent.

D.

1. Engineering 103 (Computer Methods) (Non-credit) &

2. * Select ONLY one Research area.
A.
Electrical Engineering
B.
Civil Engineering C.
C.
Science (Biology, Physics or Chemistry)

Mechanical Engineering

Pre-requites: Calculus I (with a grade of C+ or better) or AP Calculus AB (with a score of 4 or better).

* Note: Group D is only available for students who meet the additional two conditions:
(1) MUST Be a US Citizens and (2) Must Be a Junior (11th) or Senior (12th).
REFERENCES: Math and Science teacher recommendations are required.
Please Print:
1. Math Teacher: ______________________ _______________________
Last name
First Name

________________________________
E-mail

2. Science Teacher: _____________________ _______________________

Last name
First Name

________________________________
E-mail

STEM Institute 2015 Teacher Recommendation Form

Students Name: ________________________________________ Grade: __________ Date: __________________

Please indicate which classes your student is applying for:
1. _____________________________________________

2. ____________________________________________

To the Sponsoring Teacher:

Thank you for your recommendation of the above named student for the 2015 Summer STEM
Institute. Please send the recommendation form, along with your recommendation letter to:
Otto Marte, Assistant Director
Email: stem@ccny.cuny.edu
Subject: STEM Recommendation Form/Student Name
URL: http://stem.ccny.cuny.edu

1. Possesses a comfortable knowledge of basic skills and factual information ----------------------------------2. Has ability and desire to follow through on work: able to see a problem through in assigned tasks ---------3. Pursues interests to understand or satisfy curiosity; wants to know how and why. ----------------------------4. Generates questions of his/her own; questions the common, ordinary, or unusual. ----------------------------5. Enjoys the challenge of difficult problems, assignments, issues, and materials. --------------------------------6. Inclined to be independent on his/her own ideas (when appropriate) rather than relying on the structuring of
others.
7. Capable of planning and organizing activities, direct actions, and evaluating his/her own results.-----------8. Requires a minimum of adult direction and attention: possesses skills to facilitate independent work. -----9. Seems self-confident, happy and comfortable in most situations. --------------------------------------------10. Is able to cope with normal frustrations or can adapt to change with minimum difficulty. -----------------11. Able to function effectively as a group member. -------------------------------------------------------------------I2. Is receptive to new tasks or experiences; seems able to take reasonable risks. ---------------------------------

Please check the appropriate box:

I highly recommended the applicant
I recommend the applicant

I recommend the applicant with reservation

I do not recommend the applicant.

Application deadline: Friday, April 4, 2015

(See Back)

The STEM Institute 2015 Teacher Recommendation Letter

To the Sponsoring Teacher:
Thank you for your recommendation. Please take a moment to write a brief recommendation supporting the
candidacy of this student for participation in this program. Please email your recommendation to:
stem@ccny.cuny.edu Subject: students name
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Teachers Name: _______________________________________________________________Dept: ______________________________
Signature: _________________________________________________________ Phone: _________________________

Application deadline: Friday, April 24, 2015

STEM Institute 2015 Teacher Recommendation Letter

To the Sponsoring Teacher:
Thank you for your recommendation. Please take a moment to write a brief recommendation supporting the
candidacy of this student for participation in this program. Please email your recommendation to:
stem@ccny.cuny.edu Subject: students name
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Teachers Name: _______________________________________________________________Dept. ______________________________
Signature: _________________________________________________________ Phone: _________________________

Application deadline: Friday, April 24, 2015

STEM INSTITUTE
THE CITY COLLEGE
of
THE CITY UNIVERSITY OF NEW YORK
Convent Avenue and 140th Street, RM 2M-15
New York, NY 10031
TEL: (212) 650 8172/6190
FAX: (212) 650 - 8048
E-MAIL: stem@ccny.cuny.edu

STEM INSTITUTE

Official Transcript Request

Students: Please ask your parent or guardian to fill out this form, deliver it to your school
counselor, make arrangements for pick up and mailing or for your school to mail a copy of your
official transcript to the program address above.
It can also be emailed to stem@ccny.cuny.edu Subject: Student Names Transcript
Thank you.

Dear School Counselor,

My son/daughter ___________________________________ needs to submit an official transcript to

the 2015 The STEM Institute.
Would you please arrange to provide him/her with the official transcript or send it directly to the
above address. Thank you.

Sincerely,

__________________________________
Signature of Parent/Guardian

_______________________
Date

Application deadline: Friday, April 24, 2015