HSSA - Student Indication of Interest Form : Education : Nebraska Wildlife Rehab, Inc.

Please complete and submit the form below for application to High School Science Academy. Take your time and answer each question completely and thoughtfully with multiple sentences. NO NOT use AI/ChatGPT to generate your answers.

This program has limited space and the process is competitive -- the more thoughtful your application, the more we'll be able to understand why you will benefit from this program.

First Name

First Name:

Last Name

Last Name:

High School

High School:

Grade Level During School Year you are Applying For:

NON-SCHOOL RELATED Email

Email:

Phone Number

Phone Number:

Referring Teacher or Counselor

Referring Teacher or Counselor:

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What science classes have you taken and how have they formed or changed your interest in science?

What do you expect to do after high school?

Why do you want to participate in this program? (Please be thorough.)

How have you demonstrated your interest in science in and outside of school?

BHMI
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