Inspired Minds Enrollment | Soaring As Eagles

Inspired Minds Enrollment Form

is a STEAM (Science, Technology, Engineering, Arts, and Math) program designed for 5th - 9th graders.

The purpose is to broaden horizons through exposure to opportunities that lead to empowering experiences and successful careers. Once enrolled in the program, students remain connected through high school and beyond. Not only does this program provide mentorship, but also include activities such as financial literacy, music, robotics, fishing, filming, trips to college campuses, and so much more.

NOTE TO PARENT/GUARDIAN: This form is to be filled out WITH YOUR STUDENT

Student Information

First name

Last name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Phone

School

Grade

Questionnaire

What's your favorite subject(s)?

What's your least favorite subject(s)?

Interests / Hobbies ?

What are your strengths?

What are some areas you desire to become better?

What do you expect from this program?

Do you have any food or other allergies?

Are you on any medications? If so, for what?

Have you ever been suspended from school? If so, check one

0-1

2-4

5 or More

Have you ever been arrested for (check all that apply)

weapons

sexual assault

violence

If you could be or do ANYTHING in the world, what would you do for a career?

Who told you about this program?

Phone

Why do you think they told you about it?

Is there another person that recommended this program to you? If so....

Phone

Why do you think they told you about it?

PARENT/GUARDIAN

PARENT/GUARDIAN Name

Phone

Emergency Contact

Emergency Contact Name

Phone

Thanks for submitting!