ChiS&E at STEM-X

Student's Information

During the admissions process, preferred first name is used in text, email and print mail communication, including those sent to parents/guardians. Read more about how preferred first name is used on campus.

Student's First Name

Student's Last Name

Student's Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Phone Type (hidden, mobile default)

Email Address

Evening Phone

Mobile Phone

Primary Phone

Student's Cell Phone Number (used only in emergency)

Student's Birthdate

Prospective Type

Freshman

Transfer

What Is the student's grade level?

Current School

Which of the following are you affiliated with? (check all that apply)

If traveling from the Chicago area, which option will you use for traveling to and from Champaign-Urbana?

Bus from Langston Hughes Elementary School (240 W 104th St, Chicago, IL 60628)

Drive ourselves

Registration Information

Total Guests (excluding student). At least 1 parent/guardian needs to attend.

Student T-shirt Size (adult sizes)

All STEMx students must be accompanied by a parent/guardian/chaperone over the age of 18. PLEASE HAVE YOUR CHAPERONE COMPLETE THE FOLLOWING SECTION:

Guest Name (Parent/Guardian/Chaperone)

Guest(s) relationship to student attendee? Select all that apply.

Guest Cell Phone Number (Parent/Guardian/Chaperone)

Guest Email (Parent/Guardian/Chaperone):

Please list any additional accommodations needed for the student or for any participating guests (mobility, vision/hearing, first-language translation, etc).

How did you hear about this event?

Participation Consent

Portions of this programming will separate students (minors) and their guest to do/share different content and activities. Please provide your consent to the following...

Participation Consent

Portions of this programming will separate students (minors) and their guest to do/share different content and activities. Please provide your consent to the following...

I warrant that I am the parent, legal guardian, or chaperone (over age 18) of the minor described herein and have the full right and authority to grant this consent on behalf of such minor to participate in this event.

I do not consent to the minor described herein full participation in this event during the separated portions of programming and the minor will solely attend the programming scheduled for guest.

Please press "submit" only once. It may take up to one minute before reaching the confirmation page.