Canning Summer Scholar Pre-Internship Workshop

This workshop is sponsored by the SQE Inspire Program of Northwestern University Feinberg School of Medicine.

1. Name (First, Last)
2. Age
3. Your Email Address
4. Name of your high school
5. Your grade for School Year 2025-2026

5. Your grade for School Year 2025-2026 10-Sophmore 11-Junior 12-Senior
6. Please provide the name, email, and telephone number of a teacher, counselor, or mentor who can provide a brief recommendation letter for you.
7. This program will be on Northwestern University's downtown campus. Are your parents/guardian(s) supportive of you applying for this program?
8. Is commuting to class a barrier to you applying? If so, please explain.
9. Would you need assistance with travel to and from the medical campus?
10. Will you be able to commit to all 5 days of the program, June 9th to June 13th from 9:00-3:30pm?

10. Will you be able to commit to all 5 days of the program, June 9th to June 13th from 9:00-3:30pm? Yes No Maybe Other - please explain in box below
Explanation for Box 10
11. When did you become more interested in STEM (Science, Technology, Engineering and Math)?
12. Is there a particular person or event that inspired you to become more interested in the STEM subjects? (if applicable)
13. Do you participate in any extracurricular science clubs, activities, or events outside of class (including hobbies at home)?
14. Why would you like to participate in this one-week STEM program?