Last Name:

First Name:

Sex: Male Female

Date of Birth: (mm/dd/yyyy)



State: Zip:


Phone Number:



Parent(s)/Guardian(s) Name(s):

Session Preferred:

session 1 (June 14 - June 27, 2020)

session 2 (July 12 - July 25, 2020)

High School Graduation Date: (mm/yyyy)

Name of High School:

Rank in High School Class: (leave blank if HS doesn't rank) out of

GPA: (leave blank if HS doesn't keep track of GPA) out of

Have you had:

Physics? Yes No

Chemistry? Yes No

Years of Math (including this year):   1   2   3   4  

Please describe why you would like to join IEP next summer:

If your choice of sessions is already filled, can you attend the other?   Yes   No  

You will be informed of the decision concerning your acceptance within two to three weeks of submission of this application. We may request additional information at that point.