New Student TeMPEST Application

Thank you for considering the TeMPEST After-School Program!

Some Very Important Application Information

Applications can be filled out at any time, but it is strongly encouraged to register for a wave at least a week in advance.
Once you fill out an application and are approved, you will be able to sign up for the waves you would like to participate in.
Please don’t hesitate to call or e-mail Education Manager Bridget Cervero with questions:
- bcervero@maritimeaquarium.org
- 203-852-0700 x 2281

Note: Questions with an asterisks (*) are optional though answers to these questions help us secure funding to support the program and will be kept confidential. Thank you!

Student's First Name
Student's Last Name
Male or Female?	Male Female
Mailing Address
City
Zip Code
Home Phone
Cell Phone
Email
Student Birth Date
Primary Language Spoken at Home*
Does the Student Qualify for Free or Reduced Price Meals at School? *	Yes No
Parent/Guardian #1 First Name
Parent/Guardian #1 Last Name
Does this Person Live with the Student Named Above?	Yes No
Parent/Guardian #1 Day Phone
Parent/Guardian #1 Evening Phone
Parent/Guardian #1 Email
Relationship to Child *
Occupation *
Education *	Some High School High School Graduate Some College College Graduate Graduate School
Parent/Guardian #2 First Name
Parent/Guardian #2 Last Name
Does this Person Live with the Student Named Above?	Yes No
Parent/Guardian #2 Day Phone
Parent/Guardian #2 Evening Phone
Parent/Guardian #2 Email
Relationship to Child *
Occupation *
Education *	Some High School High School Graduate Some College College Graduate Graduate School
------------------------------------ Ethnic Background (Optional) --------------------------------------
Please Check One:	African American / Black White / Caucasian (includes Middle Eastern) Mexican / Mexican American / Chicano Filipino / Filipino American American Indian or Alaskan Native Other Asian (not including Middle Eastern) Pacific Islander (Micronesian, Polynesian, other) Japanese / Japanese American Chinese / Chinese American Other Spanish American / Latino (Cuban, Puerto Rican, Central American, South American) Vietnamese / Vietnamese American Korean / Korean-American East Indian / Pakistani Other
What School do You Currently Attend?
What Grade are You in?	9th Grade 10th Grade 11th Grade
Are You Planning on Going to College?	Yes No Maybe
Are You Currently or Have You Ever Been a Volunteer at The Maritime Aquarium?	Yes No
Where Did You Learn About TeMPEST? (check all that apply)	Flyer Friend in the Program Teacher Mayor's Summer Science and Engineering Program Internet Newspaper Club Fair Presentation / Event Other
-------------------------------------------Getting to Know You-------------------------------------------
Please write neatly and answer all parts of each question. You may also write or type your answers in a word doc and attach below.
Please list all extra curricular activities you are currently involved with or are planning to join this school year.
Please describe your greatest achievement.
Why does a STEM (science, technology, engineering, and math) based afterschool appeal to you? What part of STEM are you most interested in?
What does commitment mean to you?

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New Student TeMPEST Application

Some Very Important Application Information

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