BioInnovation Academy Application Form

Application Deadline: April 15, 2014

Student Information
First Name ___________________________ Last Name ____________________________ Grade (open to students rising grades 9-11 by summer 2014):________

School:____________________________ Are you an Akron Public Schools Student? YES N O If yes, did you participate in the HIPP program (Healthcare in Progress)? YES NO

Mailing Address________________________ City________________ State ___ Zip _________

Home phone number (____) ______-________ Email Address (required) _____________________

Students will be informed whether or not their application was accepted via email. Please provide an email address that is checked regularly.

Parent/ Legal Guardian Information

First Name ___________________________ Last Name ____________________________ Parent/Legal Guardian cell phone (optional) (_____) _______-_________

Email Address (required) ___________________________

Students will be informed whether or not their application was accepted via email. Please provide an email address that is checked regularly.

About BioInnovation Academy

Students will learn about designing and prototyping medical devices by:
Identifying an unmet clinical need or

medical problem
Learning about solid modeling Prototyping or engineering a medical

device

Choice of Dates (please select one): June 16-20 July 14-18

Tuition Information
The cost of the academy is $750 and will be due at the time of registration. Register before March 31 to receive a 10% early bird discount. Space is limited, so please register early to ensure placement. If you wish to learn more about scholarship information and how to apply for scholarships for the academy, please email:

entrepreneurs@abiakron.org.

Personal Statement

What do you find most exciting about the STEMM (science, technology, engineering, math

and medicine) fields and your career goals? (200words)

Personal Statement

Describe when you felt you were the most creative and why?(200words)

PleaseprovidetwoLe ersofRecommenda on
Therstle ershouldspeakaboutyouracademicperformance. Thesecondle ershouldspeakaboutyourentrepreneurialquali es.

Submission Information
Applications are due to the Austen BioInnovation Institute in Akron by April 15, 2014. Applications must be post-marked by April 15, 2014 in order to be accepted. You may send your application via ground mail or by fax.

Mail Applications to: Austen BioInnovation Institute in Akron 47 N Main Street Akron, OH 44308 Attn: Maurice Thomas, BioInnovation Academy Application Fax Applications to: (330)-535-4076 Attn: Maurice Thomas, BioInnovation Academy Application
Applicants will be informed of their enrollment by April 30, 2014 via email (to the email address(s) provided) and will have until May 15, 2014 to complete the registration process. To learn more about the academy, please visit: www.abiakron.org/BioInnovationAcademy

*Full scholarships are available to APS

students.