BVEF x Tufts - STEM Unfiltered

* Required

Student First Name*

Student Preferred Name (if different from First)

Student Last Name*

Email Address*

Student Birthdate*
- For data confirmation purposes

What grade are you / is your student currently in this year? *

School Currently Attending* - Please select from searchable list.
Note - If your school does not appear on available list, please provide as complete a school name as possible.

Parent / Guardian First Name*

Parent / Guardian Last Name*

Parent / Guardian Phone Number*

Do you have a specific STEM field that you are interested in? (Check all that apply)*

Science (Biology, Chemistry, Physics, Health/Medicine etc.)

Technology (Computers, Programming, Robotics, etc.)

Engineering (Building, Design, Problem-Solving, etc.)

Mathematics (Algebra, Geometry, Data, etc.)

Other

I'm still exploring!

Tell us more about your "Other".

What interests / activities do you have outside of school? (e.g. sports, art, music, reading, volunteer/service, gaming, etc.)

What do you hope to learn or experience during this STEM Talk?

How often do you see STEM integrated into your daily life? (Think about everyday activities, hobbies, and/or devices or items you use and consume.)

What specific questions do you have for our speakers and presenters?

Is there anything else we should know ahead of time?

Are you interested in the Tufts pre-college, pre-veterinary summer programs?

Which year are you thinking about participating in our pre-college summer program (Adventures In Veterinary Medicine)?

Which graduate program(s) are you potentially interested in at Tufts vet school?

DVM - Doctor of Veterinary Medicine

MAPP - MS in Animals and Public Policy

MCM - MS in Conservation Medicine

PhD - Doctor of Philosophy in Biomedical Sciences

What year would you potentially be starting graduate school? This is typically the year you would be graduating from college.

Photo / Video Release*

I hereby give my consent to Blackstone Valley Education Foundation (BVEF) and Tufts University to photograph or film my minor child during programming and to use the images and recordings of his/her voice in such forms as photographs, slides, movies, or videotapes in broadcasts, BVEF and Tufts University web site pages, publications and/or video displays or distribution in any manner. I understand that such images and recordings may be used for any purpose as deemed appropriate by BVEF and Tufts University and that no fees will be paid for the use of these images and recordings. I release BVEF and Tufts University and their employees and agents from liabilities that may arise from the taking of or the use of these images and recordings.

I grant permission.

I do not grant permission.

Parent Guardian E-Signature

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