Application 2015

First Name *
This is a required question
Middle Initial
Last Name *
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Gender *
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Address *
This is a required question
Scholar's Cell Phone *
This is a required question
Scholar's Email *
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Father's Full Name
Father's Work Phone
Father's Cell Phone
Mother's Full Name
Mother's Work Phone
Mother's Cell Phone
Parent Email *
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Other Email

Emergency Contact

Name *
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Relation to Scholar *
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Day Phone *
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Does the scholar have any special physical needs for which you need accomodation *
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Is this information on record with the school nurse *
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Student Responsibilities *
It is expected that all students accepted into the Weston Science Scholars Program attend and participate in all scheduled activities such as classes, seminars, laboratories, homework, community service, colloquia, and field trip events, etc. If the minimum amount of hours are not met, reduction in credits will result! A student who does not comply with the Montclair Code of Student Conduct as published in the Montclair High School student handbook will be expelled from the program at the discretion of the directors and the Dean of CSAM, Montclair State University.
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Date *
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Parent Consent *
My child has my permission to participate in this program. It is my understanding that she/he will be subject to the Montclair High School Code of Student Conduct as published in the Montclair High School student handbook.
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Date *
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