2019 student application form

NM PREP Academy 2019

NM PREP Academy

2019 Student Application Form

Program administered by the NMSU College of Engineering


NM PREP Academy Middle School: June 2-13, High School: June 16-27

NM PREP Academy is an academic and residential program designed to introduce students to

the concepts of STEM, with a focus on engineering, through project-based learning. Each day

students will participate in activities that will enhance their skills in many STEM areas. New

Mexico State University faculty and staff lead sessions. There is no charge to participate in the

program; however, participation is limited to selected students.

Who can attend? NM PREP MS Academy: Students currently enrolled in 6th – 8th grade that are interested in

science, technology, engineering or mathematics.

NM PREP HS Academy: Students currently enrolled in 9th – 11th grade that are interested in

science, technology, engineering or mathematics.

Where? NM PREP Academy occurs on the New Mexico State University campus in Las Cruces, NM,

from June 2-13 for the middle school session and June 16-27 for the high school session. Room

and board is provide to all students. It is mandatory for all participants to stay in the provided

housing for the duration of the program. Parents are responsible for the student’s transportation

to and from the program.

How to apply: Student (and Parent/Guardian) need to complete the attached Student Application Form.

Submit your application form with all other required documentation:

The deadline to submit your application is March 31, 2019. We prefer that all forms, except the

SFSP form, be digitally submitted. If you choose to mail or physically deliver application, please

include all application documents together in one packet and DO NOT staple your application.

Only complete applications are considered. You will NOT receive notification of an incomplete

application. Notification, via email, of selected participates for the NM PREP Academy are sent

on or before April 19, 2019.

If you have questions or need additional information, contact us at (575) 646-2913 or

[email protected].

Mailing Address: NM PREP Academy

College of Engineering

New Mexico State University

MSC Eng NM,

P.O. Box 30001

Las Cruces, NM 88003

Delivery Address: NM PREP Academy



Engineering Complex I, Rm. 120

1025 Stewart St.


Digital: [email protected]

Fax: 575-626-5440

Digital Form

mailto:[email protected]



NM PREP Academy

Rules and Policies

Rules and Policies

The following is a list of rules and prohibited conduct intended to assist in providing for the

health, safety and social well-being of everyone attending the NM PREP Academy. Any

reasonable suspicion that a student has engaged in such prohibited conduct, or attempted

conduct, or violation of any rule will result in the immediate dismissal from the program.

Students are expected to obey dorm rules and instructions given by staff, teacher chaperones,

and/or University Staff.

Students are expected to adhere to the dress code at all times. Undergarments should not be

showing (i.e. no spaghetti straps or baggy pants), no clothing with offensive logos, messages,

or alcohol or drug references, and all clothing should be an appropriate length not showing

excessive skin.

Students are expected to actively participate in all program classes and activities.

Students are not to walk around campus except in groups and accompanied by the program

instructor or staff.

Each student must make sure that their program mentor knows where he or she is at all times

(ask to exit to the bathroom or other areas away from group).

Students are required to be present and actively participating in their assigned activities at all

times. Disruptive behavior in classes or on field trips/excursions and unexcused absences

from any scheduled activity will not be permitted.

Dangerous or threatening conduct, disrespectful behavior, bullying (persistent,

offensive, abusive, intimidating, or insulting behavior, which makes the recipient feel

upset, threatened, humiliated, or vulnerable) and hazing (conduct that causes or

intends to cause psychological, emotional, or physical harm to any person) will not be

permitted.

Possessing, using, storing, or transporting firearms, other weapons, explosives, smoke

bombs, fireworks, ammunition, or dangerous chemicals are prohibited.

Relatives and friends are not permitted to visit or pick up students during the program.

Visitors during the program are not allowed.

Students must keep all cellphones, tablets, music players, hand-held gaming devices, and

other electronics in their dorm room. Electronic devices are not permitted in classes and

students are responsible for the location and safe keeping of these devices.

All students are to be in their assigned dorm room by 9:00 p.m. and lights out at 9:30 p.m.

No visitors allowed.

Inquiries If you have any questions or comments, please contact us at (575) 646-2913.

.


NM PREP Academy

Contact Information

NM PREP Academy

Email: [email protected]

Phone: 575-646-2913

Mailing Address Physical Location Phone: 575-646-2913 Engineering New Mexico

Resource Network



MSC Eng NM, PO Box 30001


1025 Stewart St.

Engineering Complex I,

Room 126


Fax: 575-646-5440

ENMRN Office

Program

Classrooms


NM PREP Academy

Student Application Form

Deadline: Postmarked on or before March 17, 2017

Student Information

Parent/Guardian Information

Additional Emergency Contact

School Information

Parent/Guardian’s Consent (To Be Signed by Parent/Guardian AND Student)

As the parent/guardian of the above named student, I certify that my child has my permission to

participate in the NM PREP Academy at New Mexico State University. My child is committing to attend

for the entire duration of the program. It is my understanding that they will be subject to ALL of the rules

and regulations of the program.

Full Name of Contact

Relationship Phone #

First Name Middle Initial Last Name

DOB (MM/DD/YYYY)

/ / Age Gender

Male☐ Female☐

Email Address

Mailing Address

City State Zip Code

Ethnicity

American Indian☐ Caucasian☐ African American☐ Hispanic☐ Asian/Pacific Islander☐ Other ☐

Adult T-Shirt Size

S ☐ M ☐ L ☐ XL☐

Guardian 1

Work Phone # Home Phone # Cell Phone #

Email Address Relationship Contact

1st ☐ 2nd ☐

Guardian 2

Work Phone # Home Phone # Cell Phone #

Email Address Relationship Contact

1st ☐ 2nd ☐

Student ID (if applicable) How did you hear about this program?

Teacher☐ Counselor☐ Friend☐ Online☐ Other☐

Current Grade Level

School Currently Attending

School District

Type of School

Public☐ Private☐ Charter☐ Homeschool☐ Other☐

School Location:

Urban☐ Rural☐ Sub-Urban☐

Deadline: Postmarked on or before March 31, 2019

Apply for NM PREP Middle School Academy – June 2-13, 2019

Apply for NM PREP High School Academy – June 16-27, 2019


This Page Intentionally Left Blank


NM PREP Academy

Student Essay

In your essay, tell the selection committee what world problem you hope to solve as a future engineer

and how do you see attending the NM PREP Academy helping you achieve that goal. A student-

written essay must be included with this application. The student essay is to be typed or neatly hand

written. The essay should be between 250-500 words, less than 3,250 characters and must be written

by the student. Be sure to write your name, Student ID (if applicable) and current grade level at the

top of your essay.

Name: Student ID:

Grade:


NM PREP Academy

Math or Science Teacher Recommendation

Dear Teacher,

The student who gave you this form is applying to attend the NM PREP Academy, a residential STEM program at

New Mexico State University. Please complete the recommendation below or complete the digital form found at

https://goo.gl/forms/Rkk9hxx25Xka6Ebb2. If you are submitting on paper, put this form into an envelope, seal

it, and write your name across the sealed flap, so that your comments will be private. Please return the sealed

envelope to the student or parent as soon as possible. The application deadline is March 31, 2019.

Name of Teacher

Name of student_________________________________________________ Student ID_________________

Course taken with this teacher: Subject______________________________________ Year__________________

Please put an X in the appropriate column for each of the following statements:

Always Often Sometimes Rarely Never

This student was eager to learn.

This student cared about other students.

This student was late to class.

This student skipped classes.

This student turned in homework and projects on

time.

This student participated in class, group and hands-

on activities.

This student worked independently and as a team

member.

This student was an asset to the class.

This student participated in co-curricular activities

(science fair, science club, etc.).

Do you recommend this student to the NM PREP Academy? Please include 2-3 sentences explaining why or why

not.

School Name _________________________________________________________________

Teacher Signature ____________________________________ Date__________________

https://goo.gl/forms/Rkk9hxx25Xka6Ebb2


NM PREP Academy

Teacher or Mentor* Recommendation

Dear Teacher,

The student who gave you this form is applying to attend the NM PREP Academy, a residential STEM program at

New Mexico State University. Please complete the recommendation below or complete the digital form found at

https://goo.gl/forms/Rkk9hxx25Xka6Ebb2. If you are submitting on paper, put this form into an envelope, seal

it, and write your name across the sealed flap, so that your comments will be private. Please return the sealed

envelope to the student or parent as soon as possible. The application deadline is March 31, 2019.

Name of Teacher

Name of student_________________________________________________ Student ID_________________

Course taken with this teacher: Subject______________________________________ Year__________________

Please put an X in the appropriate column for each of the following statements:

Always Often Sometimes Rarely Never

This student was eager to learn.

This student cared about other students.

This student was late to class.

This student skipped classes.

This student turned in homework and projects on

time.

This student participated in class, group and hands-

on activities.

This student worked independently and as a team

member.

This student was an asset to the class.

This student participated in co-curricular activities

(science fair, science club, etc.).

Do you recommend this student to the NM PREP Academy? Please include 2-3 sentences explaining why or why

not.

School Name _________________________________________________________________

Teacher Signature ____________________________________ Date_________________

*Mentors include, but are not limited to, robotics coach, athletic coach, or church group leader.

https://goo.gl/forms/Rkk9hxx25Xka6Ebb2


LETTER TO PARENTS REGARDING SFSP SERVICES

Dear Parent or Guardian:

We are seeking assistance for food service under the Summer Food Service Program for Children (SFSP). This program is

funded by the United States Department of Agriculture and administered by the New Mexico Children, Youth and Families

Department.

Our organization can receive reimbursements for meals served to children that meet SFSP eligibility criteria. Meals are available

and will be provided free to all children, without regard to race, color, national origin, sex, age or disability.

For purposes of SFSP reimbursement for meals served to children, free of charge, at Residential Camps, Day Camps, and Closed-

Enrolled Sites:

An Income Eligibility Application (IEA) must be completed and must contain the SFSP participant’s name, names of

all household members, current household income, a social security number of an adult household member or an

indication that a household member does not possess one, and the signature of an adult household member. Participants

with household incomes equal to or less than those indicated on the attached SFSP Income Eligibility Standards are

eligible for free meals.

Children who are part of households that receive food stamps, or benefits under the Food Distribution Program on

Indian Reservations (FDPIR), or Temporary Assistance for Needy Families (TANF) are categorically (automatically)

eligible to receive free meal benefits at eligible Program sites. Family size and income data for these children is not

required when completing the IEA but a food stamp, FDPIR or TANF case number is.

Please complete the attached SFSP Income Eligibility Application. This information will be maintained in strict

confidence.

In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race,

color, national origin, sex, age, or disability. To file a complaint of discrimination, write to: USDA, Director, Office of Civil Rights, Room 326-

W, Whitten Building, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice and TDD). USDA is an

equal opportunity provider and employer.


Form 3.3

SUMMER FOOD SERVICE PROGRAM INCOME ELIGIBILITY STANDARDS

EFFECTIVE JULY 1, 2015 through JUNE 30, 2016

HOUSEHOLD

SIZE

INCOME

YEAR MONTH WEEK

1 $21,775 $1,815 $419

2 $29,471 $2,456 $567

3 $37,167 $3,098 $715

4 $44,863 $3,739 $863

5 $52,559 $4,380 $1,011

6 $60,255 $5,022 $1,159

7 $67,951 $5,663 $1,307

8 $75,647 $6,304 $1,455

For each additional

family member

$7,696

$642

$148

NOTICES TO PARENTS/GUARDIANS

Households with incomes of less than or equal to the above values are eligible for free Program meals.

If the child/children, for whom this application is being completed, is a member of a household that receives food stamp, TANF (Temporary Assistance for Needy Families) or FDPIR (Food Distribution Program on Indian Reservations) benefits, they are automatically eligible to receive free meals in the Program.

Foster children are categorically (automatically) eligible for free meals regardless of household income.

DEFINITIONS OF TERMS

"Income" means income before deductions for income taxes, employee's social security taxes, insurance premiums, charitable contributions, and bonds, etc. It includes the following: (1) monetary compensation for services, including wages, salary, commissions, or fees; (2) net income from non-farm self-employment; (3) net income from farm self-employment; (4) social security; (5) dividends or interest on savings or bonds, income from estates or trusts or net rental income; (6) public assistance or welfare payments; (7) unemployment compensation; (8) government civilian employee, or military retirement, or pensions or veteran's payments; (9) private pensions or annuities; (10) alimony or child support payments; (11) regular contributions from persons not living in the household; (12) net royalties; (13) "Military benefits received in cash, such as, housing allowance for military households living off-base, food allowance, and uniform allowance, must be considered as income"; (14) and other cash income.

“Household” means "family" as defined in Section 7 CFR, Part 225.2. Family means in the case of children, a group of related or nonrelated individuals who are not residents of an institution or boarding house, but who are living as one economic unit.

USDA is an equal opportunity provider. Updated 1/8/16. L:\ECS Family Nutrition Bureau\Albuquerque FNB\SFSP-Summer Food\WEB Forms\Web Forms 2016\3.3Income Eligibility Standards.doc


SUMMER FOOD SERVICE PROGRAM

CIVIL RIGHTS STATEMENT

IN ACCORDANCE WITH FEDERAL LAW AND U.S. DEPARTMENT OF AGRICULTURE POLICY,

THIS INSTITUTION IS PROHIBITED FROM DISCRIMINATING ON THE BASIS OF RACE,

COLOR, NATIONAL ORIGIN, SEX, AGE, OR DISABILITY. TO FILE A COMPLAINT OF

DISCRIMINATION, WRITE USDA, DIRECTOR, OFFICE OF CIVIL RIGHTS, ROOM 326-W,

WHITTEN BUILDING, 1400 INDEPENDENCE AVENUE, SW, WASHINGTON, D.C. 20250-9410

OR CALL (202) 720-5964 (VOICE AND TDD). USDA IS AN EQUAL OPPORTUNITY PROVIDER

AND EMPLOYER.

DE ACUERDO A LO ESTABLECIDO POR LAS LEYES FEDERALES Y EL DEPARTAMENTO DE

AGRICULTURA DE LOS EE.UU. (USDA, SIGLAS EN INGLÉS), SE PROHIBE A ESTE

ORGANISMO LA DISCRIMINACIÓN POR RAZA, COLOR, ORIGEN NACIONAL, SEXO, EDAD, O

IMPEDIMENTOS DE LAS PERSONAS. PARA PRESENTAR UNA QUEJA SOBRE

DISCRIMINACIÓN, ESCRIBA A USDA, DIRECTOR, OFFICE OF CIVIL RIGHTS, ROOM 326-W,

WHITTEN BUILDING, 1400 INDEPENDENCE AVENUE, SW, WASHINGTON, D.C. 20250-9410,

O LLAME AL (202) 720-5964 (VOZ Y TDD). USDA ES UN PROVEEDOR Y EMPLEADOR QUE

OFRECE OPORTUNIDAD IGUAL A TODOS.


NM PREP Academy

Application Checklist

Deadline to Apply The deadline to submit your application is March 31, 2019. If you are mailing or delivering your

application, please include all application documents together in one packet and please DO NOT

staple your application. If submitting application digitally, you will still need to mail or deliver

the income eligibility application separately.

Application Checklist

Student Application Form (Digital Preferred)

Student Essay (Digital Preferred)

Two teacher/mentor recommendations, one must be from a Science or Math teacher

(Digital Preferred)

Copy of Fall 2018 report card (Digital Preferred)

Income Eligibility Application (Must be Mailed or Delivered)

Official Use Only

Student Application Form

Student Essay

Two teacher/mentor recommendations, one must be from a Science or Math teacher

Income Eligibility Application

Copy of Fall 2018 report card

Mailing Address: NM PREP Academy



MSC Eng NM

P.O. Box 30001


Delivery Address: NM PREP Academy



Engineering Complex I, Rm. 121

1025 Stewart St.


Digital: [email protected]

Fax: 575-626-5440

Digital Form



Engineering New Mexico Resource Network



MSC Eng NM,

P.O. Box 30001


(575) 646-2913

[email protected]

2019 student application form

Documents