Welcome to the Real Word Connections Program (Fall 2008 / Spring 2009)
Connections Program Registration Form
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First Name
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Last Name
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Please select your enrollement level or Registration type in "HS Connections Program " experience - including new programs for community & freshmen college students and middle school students ?
Course Enrollemnt Level(1)(First Time High School Students)
Course Enrollment Level (2)( Second Time High School Students)
Course Enrollment Level (3)( third Time High School Students)
Course Enrollmment Level (1) (First Time Middle School Students)
Course Enrollment Level (1) (First Time Freshmen College or Community College Students)
Parents Support Team (Parents)
Teachers Support Team (High School Teachers)
Industry Support Team
University Support Team
High School Administrator
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What location or sattelite location will you be attending the program at?
NJIT Central Location
Mount Olive High School
Freehold Bio Tech Regional School
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Preferred Email Address
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Phone Number
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High School Name
(or middle school or community college or university for freshmen - new this Fall 2007)
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Town
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Zip Code
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Grade
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Parent Full Name
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Parent Email Address
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Parent Phone Number
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What project track(s) are you interested in? (Please select all that apply)
1- Entrepreneurship Projects Track
2- Industry-Sponsored Projects Track
3- University-Sponsored research Projects Track
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What Project Theme (s) are you intesrested in? (Please select all that apply)
Criminal Justice & Law [1]
Biology, BME, Bio Tech and Medicine (2)
E-Commerce [3]
Game Development [4]
Multimedia and movie making [5]
Network & Information Security [6]
Software Engineering [7]
Telecommunications [8]
Web Applications [9]
Applied Math [10]
Applied Physics [11]
Architecture [12]
Chemical Processing [13]
Graphics and Design [14]
History [15]
Society and Technology [16]
Robotics and Automation Engineering [17]
Business and Finance (18)
Marketing (19)
Journalism, Radio and TV reporting(20)
Liberal Arts (21)
Project Management (22)
Research and Development (23)
Sports (24)
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In addition to Fall and Spring, what Summer activities in the Connections Program are you interested in?
Any Internships
Only Paid Internships
3-4 Day Summer Camp
Optionally, please use this space to tell us about your academic achievements, awards, work experience, hobbies, interests, leadership training, clubs, unique capabilities, etc.
Is there a special role you would like to play in our class or your team? (select all that apply)
Class President
Class Vice President (Recruitment)
Class Vice President (Programs and Activities)
Class Secretary
Project Manager
Assistant Project Manager
Web Master
Subject Matter Expert (Teacher)
Subject Matter Expert (Advisor)
Advisor for new students
Project Sponsor (Entrepreneur)
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How did you learn about the Survivors Experience?
Presentation at my School
Parents
Teacher
Friends at my school
Friends at another school
Showcase
Newspaper
Flyer
Internet
TV
I took a previous survivors course
Any suggestions or comments? Please feel free to add any feedback here
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Indicates Response Required