NANOTECH CAMP

2009 APPLICATION
Student Name:___________________________________________________________________________

Parent Name:____________________________________________________________________________

Address:________________________________________________________________________________

City: ____________ State: _____ Zip: _______________ County: ____________________________

Phone Number: ______________________________ Birthdate:_____________________________

E-mail: _________________________________________________________________________________

High School: _________________________________________ Fall 2008 GPA:____________________

List computer, science, technology, and math courses you have taken in high school:

________________________________________________________________________________________

________________________________________________________________________________________

List skills, interests, hobbies, honors, and awards:

________________________________________________________________________________________

I am considering a ____ 2 year ____ 4 year college degree.

List careers you are considering: ___________________________________________________________

List any employment position(s): ___________________________________________________________

Please return completed application including:

A Short Essay- about why you would like to attend the camp

Teacher Endorsement Form- completed by your math, science, or technology teachers

Student Endorsement Form- completed by your guidance counselor or administrator

Mail or fax application to:

Barbara Canfield
Northampton Community College
3835 Green Pond Road
Bethlehem, PA 18020

Phone: 610-861-5559 Fax: 610-861-4127

 NANOTECH CAMP
2009 TEACHER ENDORSEMENT
The teacher endorsement form is part of the application process for a student to be selected to
attend Nanotech Camp at Penn State University this summer. Nanotech Camp will introduce
students to career opportunities in nanofabrication. This opportunity is being sponsored by
Northampton Community College and Penn State University.

Please submit a brief statement of endorsement highlighting the Nanotech Camp applicant’s
qualifications. This endorsement should address the student’s strengths in math, science, or
technology, (i.e.: grades, class standing, general attendance, level of commitment to the subject)
and the student’s likelihood of success in a career in nanofabrication.

Applicant Name:_____________________________________________________

_______________________________________________ _________________________
Faculty Signature Date
 NANOTECH CAMP
2009 STUDENT ENDORSEMENT

Dear School Counselor/Administrator:

The student endorsement form is part of the application process for a student to be selected to
attend Nanotech Camp at Penn State University this summer. Nanotech Camp will introduce
students to career opportunities in nanofabrication. This opportunity is being sponsored by
Northampton Community College and Penn State University.

Students participating in the Nanotech Camp will be staying in a Penn State dorm room for
two nights. They will be sharing a room with one other student. Students are expected to be
able to get along well with their roommates and be respectful of the property of others.
Students will be expected to conduct themselves in a respectful and courteous manner while
attending this event. The selection team will need to keep this in mind when making their
choices. Please take a moment to rate this student on the following factors.

_________________________________CH CAMP
Student Name (Please print)
Poor Above Average Good Excellent
Attendance 1 2 3 4
Maturity 1 2 3 4
Commitment level- does student follow through 1 2 3 4
Courtesy towards others 1 2 3 4
Respect for others 1 2 3 4
Ability to work with others 1 2 3 4
Ability to work independently 1 2 3 4
Is student free of discipline problems 1 2 3 4
I believe this student will be an excellent
school representative 1 2 3 4

Comments:
______________________________________________________________________________________

______________________________________________________________________________________

_______________________________________________ ____________________
Counselor/Administrator Signature Date