Black Star Rising 2023 Interest Form
When: June 12-16, 8:30am - 3:30pm daily (Friday will be a longer day)

INTEREST FORM DEADLINE: May 12th 

HOW MANY SPACES ARE AVAILABLE: There is room for 25 students. This form is an interest form, students will confirm participation by returning their permission forms that will be sent out after the interest form closes on May 12th. Spots will be filled in the order that permission forms are received. 

Who Can Apply: 5th-8th graders from Lodi Unified and Stockton Unified School Districts

Description: Black Star Rising aims to motivate Black/African-American middle school students to learn STEM concepts through fun hands-on curriculum, to inspire students to be STEM leaders in their communities. Students will work together in teams to build Rube-Goldberg™️ type machines that they will compete with at the end of the week.

The camp will be from 8:30am-3:30pm daily at Pacific with bus pick up options in North and South Stockton. Lunch will be provided daily. Families will be invited for dinner and competition spectating on the last day.

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Student First and Last Name *
What middle school does student go to? *
Student e-mail address (use personal e-mail address, not school issued) *
Student phone number - if student doesn't have phone, write none *
Parent or Guardian Name *
Parent or Guardian E-mail address *
Parent or Guardian Phone Number *
Which location will student be dropped off at?  *
Families will be invited to spectate the final competition on Friday, June 16th. Dinner will be provided. Which timing works best for families to join in? *
Emergency Contact name and phone number *
Does the student have any allergies or dietary restrictions? Please list them.
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