SUMMER APPRENTICESHIP PROGRAM (SAP)

KENTUCKY STATE UNIVERSITY

June 23rd to July 14th, 2024

All application packages must be received or postmarked by May 25, 2024. Application packages postmarked after the deadline may not be accepted. Incomplete applications will not be considered.

Eligibility Requirements:

  1. Rising high school junior/senior
  2. Interest in STEM (Science, Technology, Engineering, and Mathematics) and related fields such as Agriculture and Environmental Studies
  3. A preferred minimum GPA of 3.0

Applicant Information

First name Middle name Last name

First name
Middle name
Last name

Email___

Email

Street ___ Apt #___

Street
Apt

City _____ State _____ ZIP _____

City
State
ZIP

County_____ Phone_____

County
Phone

Social Networking Facebook □ Instagram □ Twitter □ Other □

Instagram
Twitter
Other
(Roommate requests are accommodated when both

Race/Ethnicity ___

Race/Ethnicity

Personal Information

Gender ☐ Female ☐ Male Birthdate (MM/DD)___ ___

Female
Male
Birthdate (MM/DD)

Age (by June 23, 2024) ___ T-shirt Size ___

Age (by June 23, 2024
T-shirt Size

Name of the school you currently attend: ___

___

Grade level completed by June 23rd
10th
11th

Expected Graduation Date: Month/Year___

Expected Graduation Date: Month/Year

(Roommate requests are accommodated when both individuals mutually request each other)

If possible, I would like to room with:

with

Parent/Guardian Contact Information

Alternative Emergency Contact Information

First name Middle name Last name ___

Evening phone_____

Evening phone

Day phone_____

Day phone

Cell phone_____

Cell phone

Email___ First name Middle name

Email

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First name
Last name
Middle name
First name
Middle name
Last name

Last name

Evening phone_____

Evening phone

Day phone_____

Day phone

Cell phone_____

Cell phone

Email ___

Email

This program is supported by National Science Foundation Historically Black College and Universities-Undergraduate Program (NSF-HBCU-UP) to promote minority students' participation in STEAM-undergraduate degree programs.

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