UVA Wise STEM Governor's School Student Application

Summer 2025 Program runs June 8 through June 22

Participating students must be in attendance through the duration of the program.

We are looking for driven and responsible students who have demonstrated mature and significant achievement in community engagement and the natural and environmental sciences- both in leadership and support roles. Generally, these students should also excel academically, particularly in math, communication, English and the humanities. This program emphasizes hands- on field and laboratory research which can be intense and demanding, both intellectually AND physically! Students will be involved in strenuous activity for significant portions of the day for two weeks. So, lots of energy and a positive attitude are fundamental to a successful candidate for the program. Students who come without such willingness hinder the morale and progress of the entire program and preclude other students from participating. This is a residential program for which students receive college credit, thus participants are required to be present and in attendance throughout the entire 2 weeks of the program. Please consider these factors in your nomination/application.

This application form may completed by a teacher, administrator or the applicant’s parent. An official of the school district (usually the gifted coordinator) will rank multiple applicants from their district once the submission deadline has passed, if needed.

Please use this form to nominate each student for participation in the UVA Wise Governor's School in STEM. Applications are due by Friday, April 4, 2025. Applications without a Teacher Evaluation Form will be considered incomplete. Please contact Program Director, Terri Brown at tlb9fd@uvawise.edu with any questions.

School District Information

Name of Applicant's School District

County/City of Applicant's Residence

Name of Applicant's High School

Student Applicant Information

Student First Name

Student Last Name

Student Preferred Name

Phone

Gender

Age

Current grade

9th grade

10th grade

11th grade

Grade point average

Mailing Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Is this students mailing address the same as their residential address?

Residential Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Parent/Legal Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone

Parent/Legal Guardian Permission

The applicant's parent or legal guardian is aware of the program dates and obligations and consents to this application.

The applicant's parent or legal guardian is not aware of this application or the program dates and obligations.

The individual completing this application is unaware of the parent's or legal guardian's knowledge of the program or this application.

Additional contact information

Please enter any additional phone/email contact information for the parent/guardian.

Secondary Contact

Secondary Contact First Name

Secondary Contact Last Name

Secondary Contact Email

Secondary Contact Phone

Relationship of Secondary Contact to student applicant

Secondary contact listed here is also a custodial parent or legal guardian of the student applicant.

Secondary contact is a parent with limited or no custody of the student applicant.

Secondary contact is a relative of the student applicant.

Secondary contact is a step-parent of the student applicant.

Secondary contact is a family friend of the student applicant.

Notes on Legal Custodial issue with a student applicant's parent

Teacher's/Director's Evaluation Information

Please provide contact information for a science teacher, club sponsor, volunteer coordinator, or similar teacher/coach, who can submit an evaluation of the student's work in that field. If the evaluator does not have an email address, please enter alternative contact information. The evaluation can be completed at {enter URL here when completed}evaluation .

Name of the Teacher, Director (or similar) who will provide an evaluation of the student applicant

Email of the Evaluator

Relationship of Evaluator to Student Applicant

Select all that apply

High School Science Teacher

High School Guidance Counselor/Teacher/Director

Community Volunteer Coordinator/Director

4-H Leader or Director

Gifted Coordinator

Other Technical Teacher/Leader

Other/not listed

Evaluator's Alternate Contact Information

We need to direct the evaluator to the website of the evaluation form. If the evaluator does not have or regularly use an email address, please provide an alternative means of contacting the evaluator.

Availability

Participating students are required to participate in all aspects of the Governor's School program and consequently must be available throughout the dates of the program. Please select a description of the student nominee's availability currently.

Nominee is completely available through the program dates listed at the top of this form (Required)

Nominee has conflicts during the program dates precluding participation

Nominee may have conflicts during the program dates precluding participation

Nominee's availability unknown by individual completing this form

Other

Mental/Physical Stamina

The UVA Wise Governor's School in STEM is an intellectually and physically demanding program. While we welcome and encourage students of diverse physical abilities, physical stamina (regardless of ability) is a requirement of every student in the program. Classes and activities generally extend through a 12-hour day six days a week during which students are required to remain physically active, intensively at times. Please use one of the buttons below to best describe the student's capability with respect to this demand for physical stamina.

Student is healthy, willing and capable of participating in a rigorous, physically and intellectually demanding educational research program.

Student may have some difficulty with the physical or intellectual demands of the program.

Student may not possess the endurance, discipline, or will needed to sustain a 12 hour day that is demanding both physically and intellectually.

Student probably does not possess the endurance, discipline, or will needed to sustain a 12 hour day that is demanding both physically and intellectually.

Notes on Availability or Mental/Physical Stamina

Has the applicant ever been convicted of a criminal offense other than a minor traffic violation?

Please explain

Has the applicant ever been suspended or expelled from any school?

Please explain

First and Last Name of Individual filling out this form

Email Address of Individual filling out this form

Daytime Phone Number of Individual filling out this form

Acceptance

I understand that this program will operate under any COVID-19 protocol or restrictions in place at the University of Virginia's College at Wise at the time of the program and that participation or continuation in the program will be subject to all students abiding by those protocol.

Authentication

By submitting this form, I assert that all the information contained herein is accurate to the best of my knowledge and that I have not intentionally misrepresented anyone's identity, relationship, or personal information. I further understand that additional information will be required for participation in the Governor's School program, including legal, health and financial-aid information and that participating students can only be enrolled to receive college credit for their participation with complete, accurate and timely submission of all registration materials. Students with incomplete forms may be allowed to participate at the digression of the program director, but they will not receive college credit.

CAPTCHA

Math question 5 + 8 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

Request Information

Calculate Your Cost

Create Your Future

Open to Opportunity

Student Affairs

Elevate Your Career

UVA Wise STEM Governor's School Student Application

School District Information

Student Applicant Information

Parent/Legal Guardian Information

Secondary Contact

Teacher's/Director's Evaluation Information

Your bright future begins now.

Request Information

Calculate Your Cost

Create Your Future

Open to Opportunity

Student Affairs

Elevate Your Career

School District Information

Student Applicant Information

Parent/Legal Guardian Information

Secondary Contact

Teacher's/Director's Evaluation Information

Start Exploring

May We Suggest

Admissions

Center for Teaching Excellence

M.Ed. in Curriculum and Instruction

Support UVA Wise

Your bright future begins now.