Application to the 2003 KnowledgeBase Summer Academy
Please complete the entire application.
Contact Information
Name:
Derrick Brown
Address:
880 South Cobb Drive #2114, Marietta, GA 30060
Voice:
770.794.1562, 1.831.307.9614 (FAX)
Email:
derrick.s.brown@att.net
1.
Personal Information
[Top]
[Section 1]
[Section 2]
[Section 3]
[Submit]
1.1.
Today's Date (MM/DD/YYYY)
1.2.
Student Last Name
1.3.
Student First Name
1.4.
School
1.5.
2003-2004 Grade
1.6.
Address
1.7.
City
1.8.
State
1.9.
Zip
1.10.
Email Address
1.11.
Parents' Email Address (if different from address listed in #1.11)
1.12.
Home Phone
1.13.
Emergency Contact Name
1.14.
Emergency Contact Phone
1.15.
Hobbies and Interests
a.
Hobby 1
b.
Hobby 2
c.
Hobby 3
2.
Essay
[Top]
[Section 1]
[Section 2]
[Section 3]
[Submit]
2.1.
How do you use computers and the Internet at home and at school?
2.2.
What are your career plans? List your top three career choices.
2.3.
Do you want to start your own business? Describe your business idea.
2.4.
What social causes concern you? Please list them and describe why they are important.
2.5.
Name one person that inspires you, and tell us why.
2.6.
What do you hope to learn by participating in the KnowledgeBase Saturday Academy?
3.
Class Survey
[Top]
[Section 1]
[Section 2]
[Section 3]
[Submit]
3.1.
List all math, science, and english classes taken during the past two school years, and the grade you received in each class.
Class Name
Letter Grade
a.
Class 1
b.
Class 2
c.
Class 3
d.
Class 4
e.
Class 5
f.
Class 6
g.
Class 7
h.
Class 8
3.2.
Rate your interest in math on a scale of 1 to 5
Hate It!
Love It!
1
2
3
4
5
3.3.
Explain why you chose the rating you did in Question 2.
3.4.
Have you ever had fun in any of your math classes? Explain what made it fun.
3.5.
Describe how you learn math best.
This survey was created using the
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