APPLICATION FORM

To Apply:

  1. Review the student requirements
  2. Complete the Student Application form below.  Make sure to answer all of the questions.
  3. Your application will be reviewed by the Membership Committee
  4. Accepted students must sign the Student Contract, Code of Conduct, and Liability Waiver, and pay the annual participation fee

Contact us at info@placerrobotics.com if you have any questions.

Student Information
Name *
Name
Birthday *
Birthday
Cell Phone *
Cell Phone
Home Phone *
Home Phone
Address *
Address
Student Academic Information
Unweighted
Unweighted
STEM Coursework
Student Interest and Experience
Programs Interest *
Other
Previous Robotics Experience
Other
Which of the following skills are your strengths? *
Which of the following skills would you like to learn? *
Parent / Guardian 1 Information
Name *
Name
Cell Phone *
Cell Phone
Home Phone *
Home Phone
(Note: employer is not required, but helpful in identifying parent mentors or corporate sponsors)
Address *
Address
Volunteering
PART needs adult volunteers to manage a successful program. Please identify the areas you would be willing to help with and add details in the comments field.
Parent / Guardian 2 Information
This section is not required, but if you have a second parent or guardian we request you answer this section.
Name
Name
Cell Phone
Cell Phone
Home Phone
Home Phone
(Note: employer is not required, but helpful in identifying parent mentors or corporate sponsors)
Address
Address
Volunteering
PART needs adult volunteers to manage a successful program. Please identify the areas you would be willing to help with and add details in the comments field.
I have read the requirements page and understand that each application will be reviewed for consideration. Accepted applications must complete the Student Contract, Code of Conduct, and Liability Waiver. *