Student Interest Form - Power Mountain Engineering

Student's Name*

First Middle Initial Last

Home Address*

Street Address City State ZIP Code

Age*

Please enter a number from 13 to 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 sections in the space provided:

1. What are your top 5 favorite projects on this site?*

View the projects here.

2. List your participation in other extra-curricular activities. (i.e., Student Council, Science Olympiad, FRC, band camp, drama, FBLA, MESA, publications, athletics, etc.)*

3. List any special skills (i.e., software packages, media design, public speaking, mechanical design, manufacturing, writing, etc.)

4. List three careers that interest you:*

5. Indicate your anticipated education/degree goal beyond high school:*

Associate
Bachelors
Masters
Doctorate

Please send me Power Mountain Engineering's free email newsletter.

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I want to be contacted by Power Mountain Engineering.*

I agree.

By submitting this form, you consent to be contacted by us. We won't use this personal information for any other purpose, and it will not be shared.

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