BJRC 2018Level III Application Form Page 1

Applicant’s Legal Name:

Last Name First Middle

Program Dates: MondayJuly 09 – ThursdayAugust10, 2018 Application Deadline (by e-mail): 20 May 2018

Please read the instructions carefully. Also be sure to carefully read the information on the Website before you begin to fill out this application.

Level III applicants must be Barbados citizens,enrolled in a high school or the community college for the past 3 years, and at least 15 years of age but less than 18 years of age on July 1, 2018. However, applications from individuals who are more than 18 and less than 19 years of age on July 1, 2018 will be considered if the Level III camp is under subscribed.

It is important to use the checklist of required supporting materials near the end of this application to help you complete your application package. Please type your responses.

Please note that you need to write 1 essay, secure a letter of recommendation, and submit transcripts and exam scores. So please begin the process early to assemble your application materials.

Type your full name on every page of your application package and make sure that you complete ALL sections.

Applications will be rejected if incomplete or emailed later than11:59 pm EST on Sunday20 May, 2018.

Confirmation of receipt of a complete application package will be sent to you via e-email. Please contact us if you don’t receive confirmation by 27 May, 2018.

Section I. Student Information

Applicant’s Legal Name

Last Name First Middle

Gender Female Male Previous BJRC Participation: Level I Level II Level IIA

CSF Coding Workshop attended: Other summer programs attended:

Level Date(s) yyyy Name Date(s) yyyy

Form/Age

Current Form/GradeDate of Birth (dd/mm/yyyy)Place of Birth

Home Address

Street City ParishCountry

Mailing Address

Street City ParishCountry

Telephone

Area Code/Home Telephone No.Area Code/Cell Telephone No.

E-mail address, Skypename

E-mail address(es)Skype name

Current High Schoolor

Community CollegeSchool Name Public Private

Street City Parish Country

Letters of

Recommendation

Name of Science or Math Teacher writing recommendation Area code/Telephone no.E-mail address

Courses completed beforeMath Courses: Algebra Trigonometry Pre-calculusCalculus

BJRC beginsScience Courses: Science Biology Chemistry Physics

Courses not listed on

your transcriptNameDate(s) taken yyyy Name Dates(s) taken yyyy

NameDate(s) taken yyyy Name Date(s) taken yyyy

Name of most recentCSEC

/CAPE/Assoc. Degree

or equivalent examScienceMathEnglishDate

Subject / Mathematics / Additional Math / Pure Math / Physics / Chemistry / Biology / English / Caribbean Studies
Grade
Exam Date
Subject (Others)
Grade
Exam Date

Planning to take/re-take No Yes If Yes, state which and when (mm/yyyy)

exams before Camp starts?

Honors, awards & elected

positions of leadership

Name Date(s) yyyy Name Date(s) yyyy

Name Date(s) yyyy Name Date(s) yyyy

Planning to apply to/attend

colleges/universities? NoYes-UWI Yes-U.S.Yes-Canada Yes-U.K. Yes-Other

Which universities?

For entrance when? mm/yyyy

Most likely career aspiration:Physics Chemistry Biology Math Engineering Type of engineering (electrical, mechanical, biomedicaletc.)
Computer Science Medicine Architecture No idea Other (Please specify):

Have you ever used power tools such as an electric drill, drill press, circular saw, or band saw? Yes No

If “NO” are you willing to learn to learn how to use such tools? Yes No

Mother Father

Last NameFirst Middle Last NameFirst Middle

Area Code/Cell Telephone Number E-mail addressArea Code/Cell Telephone Number E-mail address

How did you hear about BJRC? Internet (specify) Publication (specify)

Teacher, Principal or Schoolmate Former BJRC student

Friend or Relative Other (specify)

Application Verification

  1. I understand that I: (a) must provide proof of being a Barbadoscitizen or permanent resident, or (b) must show proof of having spent the last four years continuously enrolled in a Barbadian school, and (c) must be at least 15 years old but less than 18 years old on July 1, 2018 to apply to Level III ofthe BJRC.(Applicants more than 18 but less than 19 years of age on July 1, 2018 may apply, but their applications will be considered only if there are unfilled spaces).
  1. Level III Robotics is a very demanding environment and involves the use of power tools. I understand the dangers involved in the use of power tools. Also, I certify that I have no physical handicap that would preclude my use of power tools.
  1. If selected, I certify that I will be able to participate for the full duration of the BJRC Program (July 09–August 10, 2018). If the box above is not checked, insert the days below that you will not be present at the camp (your application will not be considered if the response to this certification is left blank).

______

  1. If selected, I hereby agree to allow the Caribbean Science Foundation and the Caribbean Diaspora for Science, Technology and Innovation to use my photo, name, and academic and career interests for their website, press releases and public presentations.
  1. I further certify that the information provided in this application, my essay, and other supplementary documents provided are true and complete. I understand that misrepresentation and/or withholding information may result in the rejection of consideration for this program or termination at any time during the program.
  1. I hereby agree to waive my right to view my recommendation formand release the educational institutions and related individuals from all liability in responding to inquiries regarding my application.
  1. I release the Caribbean Science Foundation and the BJRC Program from any liability related to such inquiries.
  1. If selected, I agree to abide by all program requirements, policies and practices.

Applicant’s Signature: ______Date: ______

SECTION II

II(A) Recommendation Form

Please print all pages of the BJRC Teacher-Principal Recommendation Form below and give them to your science or math teacher, or Principal. Alternatively, the teacher or Principal can download a fillable version of the form in .docx format ()and return it to the CSF, following the instructions on the form.

Applications without this completed form submitted to the CSF by 11:59 pm EST on Friday May 25, 2018 will not be considered.

II(B) Essay

In the box below, explain why you want to participate in the Level III Robotics Camp (400 word limit)

SECTION III

Parent/Guardian Statements (for students less than 18 years of age on July 1, 2018)

Level III Robotics is a very demanding environment and involves the use of power tools. I understand the dangers involved in the use of power tolls, and I approve the use of power tools by my child.

I fully support my child's application to the Robotics camp and certify that the information provided by him/her and by me is true and accurate.

Parent/Guardian Signature: ______Date: ______

Parent/Guardian Name: ______

CHECK LIST

Use the checklist below to ensure that your application package is complete. All items must be sent to the CSF by e-mail. Check off each item as you attach it to your e-mail. Please be sure to name your attachments to reflect what they contain and also embed your last name somewhere in the filename. Attachments with file names such as “scan 0001” could cause your attachment to be misfiled. Attachments with the content upside down will annoy most reviewers. Please make sure your attachments are upright and legible. The CSF will not send incomplete application packages to the reviewers.

Essay: Why do you want to participate in robotics camp level III? (400 words maximum)

High school transcript for past 3 years (if not in English, please provide translation).

One copy each of CSEC grades (or equivalent exam) and CAPE scores if you took these exams.

Math Teacher or Science Teacher or Principal recommendation (be sure to print out the ‘BJRC REQUEST FOR RECOMMENDATION’ and send it to your math or science teacher or Principal well in advance of the due date).

Copy of your Barbados ID

Completed BJRC Application Form

Please send completed application package by e-mail with attachments (pdf or jpeg only) to: with the subject line “BJRC Level III Application [your name].” Your complete application package must be e-mailed no later than 11:59 pm EST on Sunday May 20, 2018.