Intro to MicroelectronicsTues, February 18 - Thurs, February 20**Wait List Application**

Intro to Microelectronics

Tues, February 18 - Thurs, February 20

**Wait List Application**

Powered by Griffiss Institute through the Upstate Defense Consortium for Microelectronics

The Griffiss Institute, a member of the Upstate Defense Consortium for Microelectronics, is proud to present Microelectronics Camp for 2025. Students will explore the world of small, but powerful, electronic components.

Program Information

Dates: Tues - Thurs Feb 18 - 20
Grade Level: 7th - 9th
Schedule: 9 AM - 3 PM
Location: Griffiss Institute, 592 Hangar Road, Rome, 13441
What to bring: Excitement for hands-on STEM learning and fun!

How to Apply?

To apply, fill out the following form to time-stamp your application in the order received. A follow-up email will be sent to confirm placement in the program or the wait list.

Questions? Use the comment/question box when you apply in this form, or reach out to STEM@griffissinstitute.org. We'll get back to you as soon as we can!

Update: As of 2/12, camp has reached maximum capacity and is accepting wait list notifications only. Students on wait list will be notified by email if a slot opens up.

Student Information

Student's First Name:*

Student's Last Name:*

Grade*

Grade enrolled in current school year

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School Name: *

Student DOB*

Student's Mailing Address*

Mailing address 2 (optional)

Student's City*

Student's State*

Student's Zip Code:*

Is Your Child a U.S. Citizen? *

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Medical & Behavioral Information

We ask for medical & behavioral information about your student to be well prepared to provide them with a safe and accomodating experience. Please rest assured that we treat all information with care and sensitivity.

Allergies or Special Considerations?*

Please list any allergies or special considerations for the student, if applicable. Please also note any supporting items the student will be bringing such as an epi pen.

Medications*

If your child requires medication to be taken throughout the day please note that Griffiss Institute staff do not administer medication with some exceptions, including:

Assisting a child with the use of an Epinephrine Auto Injector in the event of a life- threatening episode of anaphylaxis
Glucagon medications for type 1 diabetics experiencing severe hypoglycemia, or
Inhaler assistance in the event of a severe asthmatic episode, etc.

Please list any medications that your child will be bringing, along with your permission for your child to independently administer medication.

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Medication Type

Please list any specific types of medication, the storage needs, and any other useful information for your student's safety needs

Any other special considerations to be aware of?

Please feel free to list any other information that would be useful for program staff to know to provide a safe and accommodating experience for your student

Physician's Name*

Physician's Phone Number*

Phone

Health Insurance Provider*

Health Insurance Policy #*

Parent/Legal Guardian Information

Parent/Guardian Name:*

Parent/Guardian Phone Number:*

Please provide a number in which we can reach you during business hours if needed

Phone

Parent/Guardian Email:*

Student lives with*

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Emergency Contacts

Please provide 1-2 emergency contacts below in case the parent/guardian above cannot be reached

Emergency Contact 1*

Emergency Contact 1 Phone*

Phone

Emergency Contact 2

Emergency Contact 2 Phone

Phone

Authorized Pick-up Contacts*

Please provide the name/s of all contacts authorized to pick up your student.

Policies

The policies listed below will assist the application process, but we welcome further questions or information requests to STEM@griffissinstitute.org.

Media Release:*

If allowed, pictures may be taken of your child participating in this program and used on website and/or social media platforms.

I do hereby grant or deny permission to the Griffiss Institute to use the image of my child, as marked by my selection(s) below. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images.

-Deny permission to use my child’s image at all.

-Grant permission to use my child’s image in the following ways: I give unrestricted permission for my child’s image to be used in print, video, and digital media. I agree that these images may be used by the Griffiss Institute, as well as local media, for a variety of purposes and that these images may be used without further notifying me. By selecting any of the following, you are agreeing to the terms and conditions of the media release form.

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Demographic Information

The information you provide helps us secure grants and funding to continue offering impactful programs like this one. Demographics information are handled with discretion, hidden from application decisions and only reported in aggregate.

If you prefer not to respond to any question, simply select 'Prefer not to respond."

Ethnicity*

Used for statistical purposes & funding opportunities only

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Race*

Used for statistical purposes & funding opportunities only

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Gender*

Used for statistical purposes & funding opportunities only

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Comments or Questions

We welcome comments and questions to this provided comment box, you may also email STEM@griffissinstitute.org for any questions.

Thanks for your interest in this exciting new STEM program, we look forward to discovering and learning together with your student!

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