GSMP STEM Summer Camp 2025 Application

Monday, June 9, 2025 at 8:00 AM until Friday, July 11, 2025 at 5:00 PMCentral Daylight Time UTC -05:00

It's time to apply for GSMP Year 3! If interested in attending our STEM summer camp please submit the application below. This camp is for COMMUTER students only - no housing is provided.

Camp dates:
June 9th - June 13th (FULL)
June 23rd - June 27th (FULL)
July 7th - July 11th

Please note: We are NOT taking team requests. All teams will be doing the same activities throughout the day.

If you have any questions, please contact us at texas.academy@lamar.edu.

Camper Information

Camper First Name

Camper Last Name

Camper Preferred Name

Camper Email Address

Camper Phone Number (Please list student phone number, parents will be entered further down)

Can we text you?

Yes

Mailing Address

Country

Street

City

Region

Postal Code

Student Birthdate

How old are you?

Race

Ethnicity

Gender assigned at birth

What is your t-shirt size?

If selected to attend, do you have a preference on a particular week? (check all that apply)

Week 3: July 7th - July 11th

Do any of the following pertain to you? Please check all that apply.

Foster youth

Documented disability/IEP or 504

Free and reduced lunch or SNAP

A Vocational Rehabilitation Customer

In an Opportunity Now Class

None of the above

Does your disability require special accommodations?

Please describe the required accommodation:

Does the camper have any allergies?

What are they allergic to?

Have you competed in the Texas Science and Engineering Fair?

Have you ever competed in a local or regional science fair?

Have you attended the Governor's Science and Technology Champions' Academy?

Have you participated in a Youth Robotics Program?

Have you participated in Camp Code summer camps?

Have you attended Governor's Summer Merit Program (formerly Texas Governor's School) before?

Academic Information

Admission Type (Hidden)

What grade will you be in during the 2025 - 2026 academic year?

Do you know what you're interested in studying?

When do you plan to enroll in college?

Are you on the Honor Roll at School?

Which Honor Roll?

Are you a member of National Junior Honor Society or National Honor Society?

School Name (type in to search)

What type of school do you attend?

Please list a name and email for a current Science, Math, Engineering, or Technology teacher as a reference.

Teacher First Name

Teacher Last Name

Teacher Email

What subject do they teach?

Please upload your most recent report card, or an unofficial transcript.

Parent Information

Relationship

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Preferred Phone Number

Parent/Guardian Email

Parent Place of Employment

Would you like to list a second parent/guardian?

Relationship

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Preferred Phone Number

Parent/Guardian Email

Parent Place of Employment

Research

Campers, in order for us to continue funding FUN summer camps, please ask your parent(s) if you can participate in a short research study while at camp. This will help us secure grant funding every year!

Are you willing to participate?

Activity and Indemnity Agreement

This release is required by Lamar University. Campers will not be able to attend unless this is completed.

Is the participant under the age of 18?

First and Last Name of Parent/Guardian:

Relationship to Minor Participant:

Activity:

This is a Release of Liability, Indemnification and Assumption of Risk Agreement. Read it carefully and sign below. Completion of this form is required before the above-named Minor participates in the Activity. This document cannot be altered or modified by any verbal or written statements.

Releasees:

The “Releasees” in this agreement are the Board of Regents, The Texas State University System, Lamar University, and all regents, directors, employees, agents, and officers and volunteers of such entities.

Assumption of Risks:

To the best of my knowledge, the above-named Minor is in good health and has no physical limitations that would preclude or impede the above-named Minor’s participation in the Activity listed above (hereafter Activity). I am aware of the risks, perils and hazards connected with the Activity. I acknowledge that loss of property, personal or bodily injury, or death might result from the Activity and/or the acts of others. I voluntarily elect to allow the above-named Minor to participate and engage in the Activity knowing that the Activity may be hazardous to my property, the above-named Minor’s property and the above-named Minor. I voluntarily and expressly agree and promise that I assume full responsibility for property loss or damage, and for personal injury, including death, that I or the above-named Minor may sustain as a result of being engaged in the Activity, whether or not based on the negligence or other wrongful conduct of any of the Releasees.

Indemnification:

I ALSO AGREE TO INDEMNIFY, PROTECT, DEFEND (ON Initial DEMAND), AND HOLD HARMLESS THE RELEASEES FROM ANY AND ALL LOSS, LIABILITY, DAMAGE, OR COSTS OF ANY NATURE WHATSOEVER, WHETHER NOW EXISTING OR HEREAFTER ARISING, INCLUDING WITHOUT LIMITATION COURT COSTS AND ATTORNEY’S FEES, THAT THE RELEASEES MAY INCUR DUE TO THE ABOVE NAMED MINOR’S PARTICIPATION IN THE ACTIVITY WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES OR OTHERWISE. FOR EXAMPLE, I SPECIFICALLY AGREE TO INDEMNIFY, PROTECT, DEFEND (ON DEMAND) AND HOLD HARMLESS THE RELEASEES FROM ANY LOSSES THE RELEASEES MAY INCUR AS A RESULT OF THE ABOVE-NAMED MINOR’S INJURIES OR DEATH, AND/OR THE ABOVE-NAMED MINOR INJURING ANOTHER PERSON OR DAMAGING ANOTHER PERSON’S PROPERTY WHILE PARTICIPATING IN THE ACTIVITY. THE INDEMNITY OWED BY ME AS SET FORTH HEREIN IS SPECIFICALLY INTENDED TO INCLUDE CLAIMS CAUSED, OR ALLEGED TO HAVE BEEN CAUSED, IN WHOLE OR IN PART, BY THE RELEASEES’ OWN NEGLIGENCE.

Release:

In consideration for facilitating the above-named Minor’s participation in the Activity I, individually and as the parent/guardian of the above- named Minor, release, discharge, and agree not to sue any of the Releasees for any claims, demands, actions, and causes of action of any nature whatsoever including without any limitation any claims of negligence, arising out of any loss or damage to my or the above- named Minor’s property and/or any personal injury or death, that the above-named Minor may sustain whether or not caused by the negligence of any of the Releasees, while participating in the Activity, whether supervised or unsupervised, or while in transportation to or from the Activity. THE RELEASE, DISCHARGE, AND COVENANT NOT TO SUE SET FORTH HEREIN IS SPECIFICALLY INTENDED TO INCLUDE CLAIMS CAUSED, OR ALLEGED TO HAVE BEEN CAUSED, IN WHOLE OR IN PART, BY THE RELEASEES’ OWN NEGLIGENCE.

Intent:

I intend that this Release of Liability, Indemnification and Assumption of the Risk Agreement bind not only me, but also the members of my family and my spouse, and my heirs, assigns, and personal representatives. I intend this as a release, discharge, and promise not to sue the Releasees. I further agree that this Release of Liability, Indemnification and Assumption of the Risk Agreement should be construed in accordance with the laws of the State of Texas.

Free Act:

I acknowledge that I have read and understand this Release of Liability, Indemnification and Assumption of Risk Agreement and understand that it is legally binding. I understand it and sign it voluntarily as my own free act.

Disclaimer and Signature:

I certify that I am the parent and/or legal guardian of the above named minor participant, of lawful age (18 years or older) and legally competent to sign this agreement.

Parent/Guardian Typed Name (serves as signature):

Authorization and Release for use of Name, Image, or Likeness

Releasees: The Texas State University System Board of Regents, Lamar University, their administrators, employees, representatives and agents. (Lamar)

Consent: For good and valuable consideration, I hereby grant to Lamar full and complete rights to the use of my image (still photograph or video), with or without the use of my name, in print and electronic publications or productions promoting Lamar, The Texas State University System, its colleges and/or programs. This release is given without charge to or any remuneration from Lamar.

I authorize Lamar to (a) record my likeness and voice on a video, audio, photographic, digital, electronic or any other medium; and (b) use my name in connection with these recordings. I hereby irrevocably assign, transfer, release and convey to Lamar, in perpetuity, throughout the universe, a nonexclusive and royalty-free license to use the recordings above, as well as all intellectual property rights embodied in or pertaining to any of the foregoing and the complete right to exploit or otherwise use those recordings, in any form of medium, expression or technology now known or hereafter known or developed.

I waive the right to inspect or approve any reproduction of my physical likeness or voice or my voice recording, and I release and discharge Lamar and Board of Regents, officers, agents and employees from all claims in connection with the use of my physical likeness, voice, and name.

I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these photographs or participation in company marketing materials or other University publications. I acknowledge and agree that publication of said photos or videos confers no rights of ownership or royalties whatsoever. I understand that all recordings, in whatever medium, shall remain the property of Lamar.

Release: I hereby release and hold Lamar free and harmless from any claims of copyright, libel, slander, invasion or violation of privacy or other similar rights that I may hold or assert. I release Lamar and those acting pursuant to its authority from any and all liability for any violation of any personal, intellectual or proprietary right I may have in connection with such use by Lamar. I intend this Release also to bind the members of my family, my heirs, assigns and personal representatives. This release includes all claims, whether or not caused by Lamar’s negligence.

Indemnity: I also agree to indemnify and hold Lamar harmless from any loss, damage, liability, or costs that they may incur from the university’s use of my image, name, or voice.

I understand that all such recordings, in whatever medium, shall remain the property of Lamar. I have read and fully understand the terms of this release.

Camper First and Last Name (serves as electronic signature)

CONSENT OF PARENT/LEGAL GUARDIAN REQUIED IF ABOVE INDIVIDUAL IS A MINOR:
I am the parent and/or legal guardian of the above minor and hereby consent and agree to the foregoing terms and provisions on his/her behalf.
Parent/Guardian Typed Name (serves as signature):

Parent/Guardian Authorization, Waiver, & Consent for Over-the-Counter Medication

Over-the-Counter (OTC) Medication may at times need to be administered, if approval is indicated by the student’s parent or guardian. Please complete the following section to save time if your child needs any of these OTC medications during her/his stay. Note: Unless we have parental authorization, we cannot administer ANY medications.

I hearby authorize that the following medications may be given to my camper if the need arrises. Please check all boxes below that we may dispense.

Ointments for minor wound care, first aid as directed. (Antiseptic, anti-itch, anti-sting, antibiotic, sunburn)

Tylenol/Acetaminophen as directed

Throat lozenges and/or spray as directed for sore throat

Kaopectate or Imodium for diarrhea as directed

Rolaids or Tums for acid reflux, heartburn, or indigestion as directed

Actifed or Sudafed as directed for nasal congestion or allergy relief per instructions

Medicated lip ointment for dry, chapped lips, lip blisters, or canker sores as directed

Hydrocortisone ointment as directed for mild skin irritations, poison ivy, and insect bites

Robitussin or other cough syrup as directed

Sunscreen

Ibuprofen as directed

Micatin or anti-fungus treatment as directed for athlete's foot

Milk of Magnesia, Pepto Bismol, or Mylanta for upset stomach or nausea as directed

Benadryl for swelling, hives, allergic reaction, as directed

Visine or other eye drops for minor eye irritation

Swimmer's ear drops as directed

Medicated powder for skin irritation as directed

Calamine lotion for bug bites and poison ivy

Bug repellent

None of the above

Program staff reserve the right to use generic equivalents when available for the name brand over-the-counter medications listed above. I understand that such administration will not be done under the supervision of medical personnel. I also agree that any first aid treatment may be given as needed. I understand that these over-the-counter medications are not necessarily kept on hand and available to be administeredimmediately.

Any condition which is associated with fever, significant inflammation, and/or does not respond to the above outlined treatment will be followed-up by a consultation with the student’s parents. Parent/guardian will be contacted if any conditions develop requiring treatment with any of the above over-the-counter medications that are not checked.

I authorize the administration of over-the-counter medications to my child as indicated above. I shall indemnify, release, and hold harmless for any all purposes Lamar University, The Texas State University System, thereregents,employees, officers, directors, members, servants, agents, and volunteers (RELEASEES) against any claims that may arise relating to my child being administered the above indicated over-the-counter medications including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES.

I/We have legal authority to consent to medical treatment for the participant named above, including the administration of medication at the program hosted by/at Lamar University.

Yes

Camper First and Last Name

Parent/Guardian Typed Name (serves as signature):

Students’ Perceptions of STEM Camp Experience: A Mixed Methods Study

INFORMED CONSENT

STEM Camp Experiences Leading to Post-Secondary Educational Opportunities in STEM Career Pathways: A Mixed Methods Study

Purpose of the Study
You are being asked to participate in a research study about your experience as a participant of the Governor’s Summer Merit Program (GSMP): Innovation ColLABoration. The purpose of the GSMP study is to: 1) increase Texas school students’ familiarity and experience with postsecondary educational opportunities that lead to STEM careers, 2) increase experiential learning opportunities in collaboration with college workforce development, and industry partners that lead to STEM careers; and, 3) engage in program opportunities that allow students to explore a STEM pathway as a future major or career option. If you agree to participate in this study, you will be asked to complete an online survey that includes a rating scale and open-ended questions of your experience at camp.

The study will take approximately 20 minutes to complete, will include a pre- and post-assessment and will take place on the Lamar University campus.

Risks
This is a no risk research study. That means that the risks of participating are no more likely or serious than those you encounter in everyday activities. The foreseeable risks or discomforts include asking for your evaluation of the total camp experience as it relates to the previous questions listed in purpose of the study. To minimize those risks and discomforts, the researchers will ensure that you can withdraw from the study at any time, without any penalty.

Benefits
Participation in this study will not directly benefit you. More broadly, this study may help researchers learn more about the effects of increase students’ familiarity and experience with post-secondary educational opportunities that lead to STEM careers in collaboration.

Confidentiality
The researcher will make every effort to ensure that the information you provide as part of this study remains confidential. Your information will be collected through an online survey using the Qualtrics software system, purchased by Lamar University. All information will be confidential to the extent possible by law and saved on a password protected computer. In all records of the study, you will be known by a code number and your name will be known only to the researchers. Your name and personal information will never be shared with anyone outside of this research project. Also, we will not link personal information about you to your actual identity whenever we share information from this study so that no one will know who you are when we write about the study or tell other people about it. This information/data will be securely stored.

This informed consent form will be kept for three (3) years after the study as required by federal law and then it will be destroyed. Your identity will not be revealed in any publications, presentations, or reports resulting from this research study.

Participation
Your participation in this research is completely voluntary. If you agree to participate now and change your mind later, you may withdraw at any time. If you choose to withdraw after we have already collected information about you, all personal data shared will be shredded.

You will not receive any type of payment for participating in this study.

There is no cost to you for participating in the study.

Contact
Prior, during, and after your participation you may contact the researcher by email or phone – Dr. Tilisa Thibodeaux, tilisa.thibodeaux@lamar.edu, 409.880.2296. When asking questions about the research study please be sure to reference the researcher’s name and study title.

For concerns with any part of this study, please contact the Lamar University Institutional Review Board at rspa@lamar.edu.

Signature
You have been informed about the title of the study, the purpose of the study, the study procedures, the benefits of the study, and possible risks. You have been given a copy of this consent form. You have been given the opportunity to ask questions before signing this form.

By signing this form, I the parent/legal guardian, am giving permission for my student to participate in a research study about their experience during camp.

For a downloadable form, please click here!

Parent/Guardian Typed Name (serves as signature):

Parent Email Address

Date

Agreement

Camper Code of Conduct

Every participant, faculty, and staff associated with Innovation Collaboration will be treated with dignity and respect.

Campers are not allowed to leave campus. Anyone caught off campus will be sent home.

Please do not run, yell, or make excessive noise (except during recreation}.

Wear shoes and proper clothing at all times.

Please use proper conduct while in the dining hall. After you have eaten your meal, please put away your tray and dispose of all trash.

If you are sick or injured, please notify your team leader, or come to the Texas Academy building immediately

Use vending machines at your own risk. Lamar University is not responsible for lost change.

The schedule for the day is to be observed.

The drinking and/or possession of alcoholic beverages is strictly forbidden.

The possession, use and distribution of any illegal substances/drugs are strictly prohibited.

The possession and use of weapons or firearms of any sort is strictly prohibited.

Vandalism, disturbing the peace or inappropriate behavior during camp will not be tolerated.

Any damage will be the financial responsibility of the person(s) responsible.

The possession, use and distribution of tobacco products is not permitted at any time during camp. This includes all e-cigarettes and “vapes.”

Campers are not permitted to use cell phones during academic session or recreation. If phone is used during these times it will be confiscated and returned at the end of the day.

Any act by a camper that violates federal, state, provincial, or local law will be a violation of this Code of Conduct.

Campers and parents will sign a copy of this Code of Conduct, provide complete medical information and release form.

Any additional rules pertinent to a specific event shall be announced by the Camp Director or administration and shall be observed as part of this Code of Conduct.

By typing my name below, I understand and agree to the above Camper Code of Conduct terms and understand that this form of electronic signature has the same legal force and effect as a manual signature.

Field Trip

At the end of each camp day, the campers will be released to meet you at the pickup location of your choice. Please communicate clearly with your student about where you will pick them up.

I understand that my camper wlll be released at the end of each day to meet me at our designated pick up location

During the week of camp, on Thursday will be transported by university shuttle or van to the port of Beaumont and Spindletop in Beaumont, TX for a tour/activity. Campers who are not allowed to participate in the field trip will need to stay home this day. If the camper is late and miss the bus, the parent will be called and the camper will need to be picked up immediately.

Does the camper have permission to participate in the field trip?

I understand that this is an application to attend the Governor's Summer Merit Program Innovation ColLABoration STEM Camp and that if selected to attend my camper and I will be notified and will need to accept the spot within one week or it will go to the next camper.

Yes, I understand

How did you hear about Innovation Collaboration?

Attended Last Summer

Friend or Family

Engineering Website

School

Social Media

Texas Academy Email

Texas Academy Text

Texas Academy Website

Southeast Texas Workforce Solutions

Other

If other, please describe: