Pacific Education Institute

What is your area/topic of interest, if known?

Desired Project Length - semester, year, etc. (if known)?

Name:

Address:

Telephone:

Current High School:

School District:

Current Grade Level/Year:

I have access to the Internet.
Yes
No

Email Address:

I have access to a car.
Yes
No

If "No," I have access to other transportation (bus, bicycle...)
Yes
No
Not Applicable (if "yes" on previous question)

I am willing to dedicate time outside of school to this project. I take full responsibility for my own work and for meeting my high school graduation requirements.
Yes
No

My parents have given me permission to work with natural resource professionals for the Culminating Projects Program during the school year.
Yes
No

Parent/guardian name:

Daytime Phone:

Please describe why you are interested in an environmentally-related project. (100 words or less)

Describe what qualifications and special qualities you would bring to this project as a student. (100 words or less)

What prior experiences have you had related to the environment and the outdoors? (100 words or less)

Additional information you would like to share: (optional)