Student Interest Form - Power Mountain Engineering

Fields with an asterisk (*) are required.

Student's Name*
First Middle Initial Last
Home Address*
Street Address City State ZIP Code
Age*
Please enter a value between 13 and 18.
Birthdate*
Class*
Freshman, Sophomore, Junior, Senior
School*
Student Home Phone*
Student Email*
Student Mobile Phone
Parent/Guardian Name*
First Middle Initial Last
Parent Email*
Parent Mobile Phone
Parent Work Phone*
Please provide brief answers to the following 4 sections in the space provided:
1. List your participation in other extra-curricular activities. (i.e., Student Council, Science Olympiad, FRC, band camp, drama, FBLA, MESA, publications, athletics, etc.)*
2. List any special skills (i.e., software packages, media design, public speaking, mechanical design, manufacturing, writing, etc.)
3. List three careers that interest you:*
4. Indicate your anticipated education/degree goal beyond high school:*
- Associate
- Bachelors
- Masters
- Doctorate
Please send me Power Mountain Engineering's free email newsletter.
- Sign me up! (I can cancel at any time)
Name
This field is for validation purposes and should be left unchanged.