2024 Physicists Inspiring the Next Generation

About You

First (Legal) Name

First (Preferred/Chosen) Name

Last (Legal) Name

Date of Birth

Your Contact Information

Email Address:
(We strongly encourage you to provide a non-school issued email address that you have access to year-round and after graduation.)

Phone:

Mobile Phone: (only needed if different from 'Phone')

Permanent Address

Country

Street

City

Region

Postal Code

Do you currently have a different address where you are receiving postal mail?

Yes

No

Current Mailing Address

Country

Street

City

Region

Postal Code

About Your Supporter(s)

Parent / Supporter First Name

Parent / Supporter Last Name

Parent / Supporter Email Address

Relationship Type:

Would you like to add another parent/supporter?

Yes

No

Parent / Supporter First Name

Parent / Supporter Last Name

Parent / Supporter Email Address

Relationship Type:

About Your Education

High School Name:

What grade/level will you be in starting Fall 2024?

Expected Graduation Date:

What subject area are you most interested in studying in college?

Your Interest in P.I.N.G

What STEM or STEM-related subjects are you most interested in learning more about?

In the text box below, please share why are you interested in this program? (max. 200 words)

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