R·I·T
Rochester Institute of Technology
www.rit.edu/academicaffairs/k12
Phone: (585) 475-6307
Fax: (585) 475-2888
Office of K-12 Programs
Application for Admission
Science and Technology Entry Program
Student Information
Date:
Name:
Student ID:
Yes
Are you a New York state resident?
__________________
Grade level:
No
9th
Address:
City:
Zip Code
State:
7th
10th
8th
11th
12th
Phone Number:
Student Email:
Optional
Gender:
Female
Date of Birth: __________________
Male
Are you eligible for free or reduced lunch?
Ethnicity:
Yes
No
Don't Know
African-American/ Black*
Asian: Non Hispanic
Native American/ Alaskan Native
White: Non Hispanic
Hispanic/ Latino
Hawaiian/Pacific Islander
Bi Racial: Non Hispanic
Other: if other please list
* includes all individuals of African descent
School:
STEM High School
Edison School of Eng
R.Brown H.S.
Burger Middle School
Rush Henrietta H.S.
Greece Olympia Central H.S.
Edison School of Bus/IIT
Roth Middle School
Rush Henrietta NGA
Greece Apollo Middle School
Parent/Guardian Information
Name:
Address same as above
Address:
City:
State:
Zip Code
Phone Number:
Parent Email:
Optional
Mr. Rick King (Edison H.S. and Greece Olympia )
Rochester Institute of Technology
STEP Coordinator
Cell # (585) 315-8023
Email: [email protected]
Science and Technology Entry Program | Application for Admission
Ms. Angela Lyman (Rush Henrietta H.S.)
Rochester Institute of Technology
STEP Coordinator
Cell # 585 794-3639
Email: [email protected]
R·I·T
Rochester Institute of Technology
www.rit.edu/academicaffairs/k12
Phone: (585) 475-6307
Fax: (585) 475-2888
Office of K-12 Programs
Photo Release
The RIT Office of K-12 Programs regularly photographs and videotapes sponsored activities
and events. These photos and/or videos may be used in promotional materials such as
brochures, advertising, or website publications. We need your permission to use photos/
videos of you for promotional purposes only.
I give permission to the RIT Office of K-12 Programs to use photos or videos of me
for promotional purposes.
Name
Signature
Date
If you are under the age of 18, we require a parent or guardian’s signature.
Parent/Guardian Name
Parent/Guardian Signature
Date
STEP Student Contract This section must be signed to complete the application.
I,
, agree to participate in the RIT Science and
Technology Entry Program (STEP). As a member of STEP, my academic progress will be
monitored throughout the course of the program. I will be on time for activities that I
am scheduled to attend, and I will follow the Code of Conduct of my school whenever I
participate in STEP activities. I understand that my signature on this document
constitutes an agreement between me and the Rochester Institute of Technology STEP
Program.
Student Signature
STEP Parent Contract
Date
This section must be signed to complete the application.
I (We),
,
give permission for
to participate in the RIT Science
and Technology Entry Program (STEP). I (We) authorize the RIT STEP Program Coordinator to obtain
economic eligibility information if applicable, review school records to monitor the academic
progress of my (our) child while in STEP. When applicable, share pertinent information with
Collegiate STEP (CSTEP) programs for college application. I (We) understand that RIT STEP staff will
keep all information confidential.
Parent/Guardian Signature
Date
Parent/Guardian Signature
Date
Please return completed application to the main office STEP mailbox
The RIT STEP project and activities are supported by a grant from NYSED
RIT complies with all government requirements of non-discrimination on the basis of age, color, religion, creed, disability,
marital status, veteran status, national origin, race, gender or sexual orientation