New York Tech Middle School Maker Academy Application

Applicants are accepted on a rolling basis. Admission is limited to 40 students. Once the program has reached capacity, your child will be put on a waiting list.

Additional forms will be sent to the email address provided below if your child is accepted into the program. Parents must complete and return all the required forms to finalize registration.

It is expected that if you apply to this program, your child is committing to attending the full week-long academy on July 29 – August 2. The program runs for five days, Monday through Friday, and the final presentation date on August 2. Transportation is not provided.

Applicant Information

Student First Name^*

Student Last Name^*

Parent First Name^*

Parent Last Name^*

Parent Phone Number^*

Parent Email Address^*

What is your child's home address?^*

Address 1^*

Address 2

City^*

State^*

Zip^*

Any Dietary Restriction?

What grade will your child be entering in the Fall?^*

6th

7th

8th

Which New York Tech Campus would you prefer your student attend?^*

Long Island

New York City

IF THE PROGRAM IS FULL AT YOUR REQUESTED CAMPUS, WOULD YOU BE INTERESTED IN YOUR CHILD ATTENDING AT OUR OTHER CAMPUS?^*

Yes

If the program is full, are you interested in your child being put on a waiting list?^*

Yes

What middle school does your child attend? (Name, City, State)^*

Does your child require special accommodations to participate in the VOYA Middle School Maker Academy?^*

Yes

THIS PROGRAM RUNS MONDAY THROUGH FRIDAY, 10 A.M. – 4 P.M. CHECK THE BOX TO CONFIRM YOUR CHILD CAN ATTEND ALL FIVE DAYS.^*

Can Attend All Five Days

Please mark all of the following your child has hands-on experience using (experience is NOT required for program participation, we are just curious!):

3-D Printing

Laser Cutting

Robotics

Programming

Virtual Reality

Augmented Reality

N/A

Are you familiar with design thinking?^*

Yes

Maybe

This program is made possible with support from Voya Foundation. The following questions provide us with demographic information about student participants and their families. This enables us to ensure we provide resources to school districts demonstrating need. Please complete the following questions:

Gender^*

Female

Male

Other

Prefer Not To Answer

Highest education level attained by parents/guardians^*

Elementary

High school

College

University

Post-University

Other

Prefer Not To Answer

Ethnicity^*

Asian

Black

White

Filipino

Hispanic/Latino

Native American

Two or more

Other

Prefer Not To Answer

Emergency Contact Information

First Name^*

Last Name^*

Relationship to Student^*

Address 1^*

Address 2

City^*

State^*

Zip^*

Cell Phone Number^*

Note: You must also complete and return these forms by the required due date.

Please enter the characters displayed in the image below.^*