2021 STEM Mountaineer Connection Application

Last Name

First Name

Middle Initial

SU ID#

Birth Date

Shirt Size

Dietary Needs (ie: Allergies or vegetarian)

Address (Street, City, State, Zip Code):

Cell Number

Alternate Ph. Number

Email:_____ @Schreiner.edu

Alt Email:_____@______

Completed FAFSA: Y/N

Primary Language

Secondary Language

Degree Plan

Select or enter value

Other

Participation enchance your goals @ Schreiner

Learning Community

Select or enter value

Math courses taken, strengths & weaknesses

Highest Level Mathematics

Select or enter value

Technology courses taken, strengths & weaknesses

Why Mountaineer Connection

Are you interested in obtaining information regarding the grant?

Select or enter value

What motivates you?

Favorite Drink

Favorite Snack

What expectations do you have for this experience?

Do you have access to a computer?

Do you need to share your computer?

Do you have access to internet?

Does your computer have a Microphone and speakers?

Does your computer have a camera?

Notes

Sign

Date

Send me a copy of my responses