Innovation ColLABoration Summer 2023 Registration Form

We are excited to see that you are interested in applying for the Texas Govenor's School Summer 2023 Innovation ColLABoration Camp!

Innovation ColLABoration is a STEM focused camp that will allow high achieving students to learn in labs within the areas of engineering, math, science, and robotics. Some examples include learning about algorithmic thinking through the creation of Lego figures, learning about chemical reactions by producing chocolate from raw coco beans, and problem solving with robots, and many more.

Students will also visit local refineries, learn leadership, problem solving and collaboration skills through recreational activities.

Requirements:
14 years of age by Fall 2023
Minimum 3.0 GPA

The two COMMUTER camp options are:

June 19th - 23rd

June 26th - 30th

Student Birthdate

Student Information

Student First Name

Student Last Name

Student Phone Number

Can we text you?

Yes

Mailing Address

Country

Street

City

Region

Postal Code

How old are you? (Must be 14 years old by first day of school Fall 2023)

For which session are you applying?

Student Email Address

Ethnicity

Gender assigned at birth

What is your t-shirt size?

Please list all organizations that you are involved in. Include any officer positions you have held or awards earned.

Please list your community activities and group memberships.

Please list any other activities or achievements you would like the selection committee to consider.

How did you hear about Innovation Collaboration?

Admitted Student Day

Facebook

Friend or Family

Engineering Website

School Administrator

School Flyer or Newsletter

School Website

Texas Academy Email

Texas Academy Text

Texas Academy Website

Parent Information

Relationship

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email

Parent/Guardian Employer

Parent/Guardian Job Title

Parent/Guardian Work Phone

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/Guardian Employer

Parent/Guardian Job Title

Parent/Guardian Work Phone

Academic Information

Admission Type (Hidden)

Current Grade

What semester will you start college?

What is your current Student ID number?

What are you interested in studying?

Are you on the Honor Roll at School?

Which Honor Roll?

What Math course will you be enrolled in for the Fall 2023 - Spring 2024 academic year?

What Science course will you be enrolled in for the Fall 2023 - Spring 2024 academic year?

What Technology course will you be enrolled in for the Fall 2023 - Spring 2024 academic year?

What Engineering course will you be enrolled in for the Fall 2023 - Spring 2024 academic year?

School Information

District Name

School Name (type in to search)

What type of school do you attend?

School Phone

School Address

Country

Street

City

Region

Postal Code

Required Documents

All campers must have the following docs completed prior to arrival for camp.

Mandatory Indemnity Form (electronic submission)

Photo Release Form (print and bring to camp)

Optional Medication Form (print and bring to camp)

Research

If you are between the ages of 14-17, you are invited to participate in a research study because you are a participant in the Texas Governor’s School: Innovation Collaboration STEM Camp. The research includes your opinions and evaluation of your camp experience. Your participation will help us improve future camps.

Would you like to participate?

Student Perceptions of STEM Camp Experience that Impacts Career Pathways: An Interpretive Mixed Methods Study

Invitation to Be in a Research Study

You are invited to volunteer for a research study. You are invited to take part because you are a participant in the Texas Governor’s School: Innovation Collaboration STEM Camp.

Purpose of Research

We are doing this research study to learn about your experience as a participant of the STEM camp experience. The study will ask questions such about the following:

(1) expose students to STEM careers and college majors that support those careers;
(2) increase experiential learning opportunities in collaboration with industry partners that lead
to STEM careers;
(3) utilize college readiness tools that allow students to explore a STEM pathway as a future
major or career option; and,
(4) participate in experiential learning activities and simulations to prepare for the workforce.

Your Rights

It is important for you to know that being in this study is completely up to you. You may decide to quit this research study at any time and do not have to worry that anyone will be upset with you for quitting. If there are any changes in the study that might affect you, you will be told about them.

Procedures

Your part in the project will last approximately 10 minutes. Your answers will be recorded on a computer in the online Qualtrics software program provided by Lamar University. Answers will be saved in the software program and only shared with the primary investigators of this study.

Alternatives

At any time, you may decide that you do not want to continue to be in this study.

Risks

There is a chance that some questions may make you feel uncomfortable. You may refuse to answer questions at any time during the online survey.

Benefits

No benefits will directly impact you, as a participant of this study. However, the study will allow the investigators and leaders of the camp to make changes regarding program effectiveness.

Costs

Being in this study will not cost you anything, other than the time spent during the online survey.

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.

Questions

You will receive a copy of this form. If you have questions, contact Dr. Tilisa Thibodeaux at (409)

880-2994 or tilisa.thibodeaux@lamar.edu. Lamar University’s Institutional Review Board has

approved this project. The research team and the University’s Institutional Review Board (a panel of

doctors, scientists and community advocates who have the job of making sure the rights and welfare

of study participants are protected) are careful to protect your privacy and limit the disclosure of

identifying information about you. You may reach the Office of Research and Sponsored Programs

at (409) 880-7672 with any questions or concerns.

ASSENT TO BE IN A RESEARCH PROJECT

Minors (individuals under the age of 18) are not legally able to consent to research. Consent must be provided by the participant’s parent or legal guardian. If a child is of an age and mental ability that s/he can understand the concept of research and research activity, the child’s assent must be sought and documented in addition to the parents.

Minor Assent

By signing below, you agree that the above information has been explained to you and all your current questions have been answered. You understand that you may ask questions about any aspect of this research study during the study and in the future. By signing this form, you agree that your child may participate in this research study.

Parent Electronic Signature

Minor’s Assent: This research has been explained to me and I agree to participate.

Minor's Electronic Signature

Additional Signage (if needed)

In some cases, consent cannot be obtained from an adult participant because the research participant lacks the ability to read and comprehend the consent form (for example, the participant may have diminished cognitive abilities). In such cases, the researchers should seek the participant’s assent to participate in the study and the consent of the person legally responsible for the participant. If the participant does not wish to participate in the study, he/she cannot be enrolled in the study unless the person legally responsible for the participant determines that it is in the participant’s best interest.

Adult Assent

If you cannot give legal consent to take part in this study because you may have trouble reading or understanding this consent form, then the researcher will ask for your assent. Assent is your agreement to be in the study. The researcher will explain the study to you in words that you can understand. You should ask questions about anything you don’t understand. Then you should decide if you want to be in the research study. If you want to participate, you or someone who can sign a legal document for you must also give their permission and sign this form before you take part. By signing below, you agree to participate in this study:

Participant's Electronic Signature

If you have authority to consent on behalf of the above-named participant, please sign your name and indicate your relationship to the participant.

Participant's Legal Guardian Signature

Relationship to Participant

Agreement

Camper Code of Conduct

Every participant, faculty, and staff associated with Innovation Collaboration is a to 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 during camp.

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.

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.

On the last day of camp campers will be transported by university shuttle or van to Exxon Mobil or IPS in Beaumont, TX for a driving tour of the refinery. Students who do not participate in the field trip will remain on campus to participate in industry sponsored labs. Does the student have permission to participate in the field trip?

Date

Merging Field (Hidden, needs to be on all forms that gather entry term/admission type/program/grade)