Student Interest Form Fields with an asterisk (*) are required. Student's Name* First Middle Initial Last Home Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Age*Please enter a value between 13 and 18.Birthdate* Class*Freshman, Sophomore, Junior, SeniorSchool*Student Home Phone*Student Email* Student Mobile PhoneParent/Guardian Name* First Middle Initial Last Parent Email* Parent Mobile PhoneParent 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:*AssociateBachelorsMastersDoctoratePlease send me Power Mountain Engineering's free email newsletter. Sign me up! (I can cancel at any time) NameThis field is for validation purposes and should be left unchanged.