REGISTRATION AND CONTACT INFORMATION

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1 Information about camp: This program will involve students ages 11 through 17 years of age that show interest in Science Technology Engineering & Math. The three-day summer camp will give students an understanding in the field of S.T.E.M. Students will get hands on training/techniques on Scientific researching skills, utilizing basic Technology to collect data, Engineering team building skills & mini workshops. Apply Mathematical applications to surrounding environments. CDTE STEM program will select 16 youth campers for this camp. Registration fee is NOT required. Application forms are available at Department of Diné Studies & Education office and STEM Equity office. Application DUE July 6 th, REGISTRATION AND CONTACT INFORMATION Diné College Diné Studies & Education department P.O. Box C-15 Tsaile, AZ Filiberto Vecenti at (928) FAX: fsvecenti@dinecollege.edu

2 Application Packet July 13 th July 15 th, 2018 Diné College, Tsaile, AZ Application Checklist Complete application packet must include the following: Application Form 2018 Letter of interest Emergency Contact Form Appearance Release Form Diné College Liability Form Your complete application is due by July 6 th, You can submit application via scanned documents, photo copies or by mail paper copies to contact below. REGISTRATION AND CONTACT INFORMATION Diné College Diné Studies & Education department P.O. Box C-15 Tsaile, AZ Filiberto Vecenti at (928) FAX: fsvecenti@dinecollege.edu

3 Application Form 2018 Student s Information Complete the following sections (Please use pen and print legibly) Student s Name: Nickname: Gender: Date of Birth: School: Grade: Attended other camps before? Year(s) attended: Student s Signature: Date: Guardian s Information Complete the following sections (Please use pen and print legibly) Parents/Guardian Name(s): Mailing Address: Daytime Phone: Parent/Guardian s Signature: Date: Acceptance of application constitutes a learning commitment contract that the student will attend 2018 CDTE STEM Summer Camp to be held in Tsaile, AZ July 13 th to July 15 th, 2018 from 8am to 5pm. The Signatures above indicate that you understand that meals will be provided for the student and that CDTE STEM Camp offers free of charged and the student agrees to abide by the rules and regulations of the camp.

4 Letter of Interest (To be completed by the student) Please use pen and print legibly Please, tell us: 1. Why does CDTE STEM Camp interest you? 2. What are your educational goals? 3. Anything interesting that you would want to share with us?

5 Emergency Form (To be completed by the guardian) Please use pen and print legibly Student s Name: Date: The information on this card will be held confidential for use in case of an emergency In case of an emergency, please contact: Name: phone 1: Relationship: Phone 2: Name: Phone 1: Relationship: Phone 2: Please list any significant health conditions that we should be aware of. For example, allergies (including allergies to medications or food), diabetes, heart or circulatory conditions, epilepsy. Please list any medications your child is currently taking including the name of the medication, the dosage, and the frequency of use.

6 Appearance Release Form (To be completed by the guardian) Please use pen and print legibly I authorize Diné College Diné Studies & Education STEM Camp to use any photographs or video taken of me throughout the 2018 summer STEM Camp for the purpose of academic publication, institutional reporting, promotion or visual data collecting, without further compensation to me. All negatives, positives or digital capture files, together with the prints and video(s) shall constitute the property of Diné College Diné Studies & Education project, solely and completely (Please Check one below) YES Print Students Name: Signature of Student: Date: Signature of Parent/Guardian: Date: -----If you do not want any photos or video of your child to be used, sign below---- NO Signature of Parent/Guardian: Date:

7 Equipment & Resources What to Bring! If you have any questions about what to get, please ask us. There are several things that you should bring with you and not bring with you. Because we are building a close supportive group there are certain items that can hinder the experience. No jewelry, wallets, makeup or any source of electronic device CDTE will not be responsible for lost of items. Most importantly zero-tolerance of weapons, illegal drugs, alcohol or tobacco products during CDTE STEM Camp. Clothing Work clothes - You ll may need to wear long pants while attending this camp. Two pairs of cheap, light colored, light weight khakis or polyester-blend work pants or comfortable jeans are best. One or two light weight long sleeve shirt for sun protection and a few t-shirts will work great for the entire crew. These clothes will definitely come home dirty so don t bring your favorites! There is a saying in the outdoor world that cotton kills. When it gets wet, cotton does little to maintain warmth, soaks completely, takes a long time to dry, and gets very heavy. Wool and synthetic material maintain warmth even when they are wet. Consider this when you are packing, and if it is possible, please bring a few pieces of non-cotton clothing. Shorts A pair to wear when we are not working, either just hanging around camp Shirts A T shirt or tank top to wear when we re not working Long sleeve shirt and pants For when we are working Warm layers It can get a little chilly, especially at night or in wetter weather, so a warm fleece or wool sweater will work perfectly. Rain Gear A waterproof raincoat. It will probably get dirty. Warm Hat either wool or fleece. No cotton. Sun Hat a wide brim hat will protect your ears, but a baseball cap or a visor will do. Underwear a few pairs will do...you know what you need! Socks To keep your feet happy and blister free, bring a pair of wool, wool blend, or synthetic hiking socks. You may bring cotton socks for non-work times but you should wear the wool socks with your work boots. Tennis Shoes and sandals You are required to wear closed toed shoes while cooking and some kind of shoes or sandals while swimming. Hiking Boots Sturdy all leather boots are required for this program. All leather, hiking boots that are comfortable. Boots will protect your feet from rough Terrain.

8 Equipment & Resources Equipment you should consider bringing: Small Backpack (daypack) every day we will load up our backpacks with everything we need for the day. Your bag should be big enough to carry a lunch, two or three liter sized water bottles, extra clothes, rain gear, and anything else you want to carry. It should be comfortable. Leather work gloves. Heavy duty gloves that are all leather or have all leather palms. Sunglasses- these are important. If you wear prescription glasses, there are clip-ons or over-glasses available at drug stores. Toiletries Only necessary items. No make up or perfumes. Bring toothbrush, toothpaste, feminine items, bug spray if you want it, sun screen, etc. Water Bottles Two liter sized water bottles. No glass. Nalgene or metal water bottles work great. Headlamp or flashlight - A headlamp is a bit more useful but either will work. Prescription Medicines bring sufficient amounts in their original bottles Sleeping Gear 1 to 2 person Sleeping bag and sleeping pad. You should bring a down or synthetic sleeping bag rated to at least to 40 degrees. The cocoon style bags are warmer than the rectangular style. No cotton sleeping bags! Night temperatures will average in the 50s. For sleeping pads, you ll want either a closed foam or open-cell (Therma-rest type) pad. Optional Towel Book Journal Camera

9 Food Preference As we will be purchasing all of the food for the program before you all arrive is makes it much easier for us if we know how you like to eat. The more detailed you are the better! If you were stranded on an island and could eat only one food what would it be? What foods do you dislike? Do you love or dislike spicy food? Do you drink coffee? Tea? Do you have a favorite dish you like to cook? What are the ingredients?

10 2018 CDTE STEM Camp CDTE Science Technology Engineering Math Camp CDTE STEM Camp

11

12 Appearance Release Form Message to applicant Once finished with this application please send back to CDTE STEM contact person. Please wait for a notification either by phone call or to let you know if you were selected for the camp. You may also inquire about the application status we will be glad to respond with an answer in a timely fashion. Thank you!

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