Jasper Campus STEM Academy 2026

Email Address

First Name

Preferred Name

Middle Name

Last Name

Mailing Address

Country

Street

City

Region

Postal Code

Birthdate

Mobile Phone

Gender

Ethnicity

T-shirt Size

School Information

High School Name

What grade will you be in beginning Fall (August) 2026?

Check all that apply to you.

I am a First-Generation College Student (if neither parent has completed a four-year college degree, you are a first-generation college student)

I have attended other Vincennes University Camps

I am a JAG student

I am a 21st Century Scholar Student

I am an ETS student

I am a Project ASPIREE student

None of these apply to me

Camp Names

Family Information

Family Income

Total number in household.

Emergency Contact

The information provided in this section along with student contact information will be used to send emails about camp as it gets closer. It is suggested to provide parent or guardian information.

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Relationship

Emergency Contact Email

Emergency Contact Phone

Interests

Please rank your interest in the following STEM fields. Some example careers for each field are listed in parenthesis.

Technology or Computer Science (computer programming, software development, cyber security, IT support)

Not Interested

Interested

Very Interested

Technology or Computer Science (computer programming, software development, cyber security, IT support)

Biological Science (forensic science, genetics, zoology, marine biology, veterinarian/vet tech)

Not Interested

Interested

Very Interested

Biological Science (forensic science, genetics, zoology, marine biology, veterinarian/vet tech)

Chemistry (pharmaceutical development, food science, pharmacy, chemistry and materials science)

Not Interested

Interested

Very Interested

Chemistry (pharmaceutical development, food science, pharmacy, chemistry and materials science)

Physics (physicist)

Not Interested

Interested

Very Interested

Physics (physicist)

Earth Science (geoscience, meteorology, mining and geological engineers, astronomy, environmental science, natural resources, forestry)

Not Interested

Interested

Very Interested

Earth Science (geoscience, meteorology, mining and geological engineers, astronomy, environmental science, natural resources, forestry)

Agriculture (horticulture, animal science, agribusiness, landscape design, urban agriculture)

Not Interested

Interested

Very Interested

Agriculture (horticulture, animal science, agribusiness, landscape design, urban agriculture)

Engineering (electrical, chemical, civil, mechanical, nuclear, aeronautical, industrial, computer)

Not Interested

Interested

Very Interested

Engineering (electrical, chemical, civil, mechanical, nuclear, aeronautical, industrial, computer)

Mathematics (actuaries, data analysis, accounting)

Not Interested

Interested

Very Interested

Mathematics (actuaries, data analysis, accounting)

Skilled Trades (advanced manufacturing/robotics, architecture, automotive, construction, diesel, electronics, precision machining, product design, surveying, welding)

Not Interested

Interested

Very Interested

Skilled Trades (advanced manufacturing/robotics, architecture, automotive, construction, diesel, electronics, precision machining, product design, surveying, welding)

Medical Sciences (nursing, occupational therapy, physical therapy, x-ray tech, pharmacy tech, medical doctor, dentist/dental hygienist, chiropractor, physician assistant)

Not Interested

Interested

Very Interested

Medical Sciences (nursing, occupational therapy, physical therapy, x-ray tech, pharmacy tech, medical doctor, dentist/dental hygienist, chiropractor, physician assistant)

What are your reasons for wanting to participate in STEM Academy?
Please check all that apply to you.

Gain hands on experience in STEM fields

Love of STEM subjects

Help narrow down which field(s) of STEM you're most interested in

Network with other students interested in STEM fields

Learn more about careers in STEM

Gain experience with STEM in a college setting

Other

Please explain in 1-2 sentences.

Camper Agreements

Youth Code of Conduct

I have read and understand the Youth Code of Conduct

Yes

No

Acceptable Use Agreement for Internet

I have read and understand the Acceptable Use Agreement for Internet

Yes

No

Authorization, Release & Informed Consent Form

I have read and understand the Authorization, Release & Informed Consent Form

Yes

No

Signature:
By typing your name, you have read, understand and agree to the terms of the Vincennes University Pre-College Programs Youth Code of Conduct, the Acceptable Use Agreement for Internet, and the Authorization, Release & Informed Consent Form.

Set Entry Term Unknown Tag (Hidden)

Parental Agreements

Parental Consent

I consent to having my student participate in Vincennes University Jasper's STEM Academy.

Photography and Social Media Release:
I assign and grant Vincennes University, and their authorized representatives or agents, the right and permission to use and publish the photographs, film, video, or other electronic or sound recordings made of my child during camp activities. I hereby release Vincennes University, camp coordinators, and all employees, volunteers, and related parties, from any and all liability associated from such use and publication. I further authorize the reproduction, sale, copyright, exhibit, broadcast, storage, and distribution of said media without limitation at the discretion of Vincennes University and I specifically waive any right to compensation I have for any of the aforementioned.

Yes

No

Liability Waiver, Release, and Hold Harmless Agreement

I have read and understand the Liability Waiver, Release, and Hold Harmless Agreement

Yes

No

How did you hear about this camp?

Payment Due at Confirmation Page

Please click the "Submit Payment" link on the Confirmation page to make your payment.

There is a $25 registration fee. If financial assistance is needed, please complete the Google form found here.

Fee Waiver Code