Fillable 2019HTU Student Application (Lower Columbia College)

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2019HTU Student Application (Lower Columbia College)

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SEMI HIGH TECH U
A High Tech Career Exploration Program
Spring Break Aprilnd – 4th, 2019
How does the program work?
SEMI High Tech U (HTU) is a three-day high-tech career exploration
program for high school students presented by the SEMI Foundation and
Lower Columbia College. Activities hosted at NORPAC, Cowlitz County
PUD and Lower Columbia College.
There is no cost for students to attend.
Food is provided each day.
Transportation will be arranged from LCC to other host sites.
This is a three-day field trip. If you are accepted, you and your
parents will be requested to attend Parent Night on Monday, April 1,
2019. This is a one hour orientation session from 5:30 p.m. –6:30
p.m. at Lower Columbia College located at 1600 Maple Street,
Longview, WA. in the Health & Science Building (HSB) 101.
Please call Lower Columbia College for more information at
(360) 442-2610, or contact: bdelmar@lowercolumbia.edu
How can I apply?
Since this is a three-day field trip, you must arrange transportation to
and from Lower Columbia College each day.
You must agree to attend all three days and display the following desired
behaviors at the program:
Show a positive Attitude
Be a team player
Demonstrate an interest and aptitude in high tech
Complete the application and submit by 5:00 p.m.
THURSDAY, MARCH 14TH, 2019.
Applications received
after this date will be considered if
space is still available.
SEMI High Tech U Application & Consent Form
CONTACT INFORMATION: Please complete the following (print carefully)
Student Name (Last) (First)
Female
Male
Age
Birthday (mm/dd/yr)
Home Address
Home Phone
City/State/Zip
Cell Phone
High School
District
Student Email (please print clearly)
Grade Point (GPA)
Grade in School
9 10 11 12
Expected Graduation Date
Ethnicity
Are you a US Citizen? Yes No
How did you hear about HTU?
If accepted please email a photo of yourself to semifoundation@semi.org for your badge. Your resume will
be required on day three of the program. If you would like a template email us at semifoundation@semi.org.
Emergency Phone Number
Parent/Guardian Email
Describe your extracurricular activities (sports, clubs, youth groups, etc.):
Describe your interest in high tech and your reasons for applying to this program:
MEDICAL EMERGENCY RELEASE AGREEMENT: The SEMI Foundation cannot authorize Medical
treatment, if needed, unless this form is completed and signed.
List any special dietary needs (i.e. vegetarian, lactose intolerant)
Do you have any allergies No Yes
Do you have any medical/attention issues, health risks or special needs: No Yes
The undersigned hereby gives permission for representatives of the SEMI Foundation, Lower Columbia
College and HTU sponsors to authorize emergency medical treatment as may be deemed necessary,
while participating in HTU.
Student Name
Parent/Guardian Name
Insurance Company
Insurance Policy Number
VIDEO, PHOTOGRAPHY AND STUDENT COMMENT RELEASE AGREEMENT:
I agree to release all said rights to any photography or video taken in connection with SEMI High Tech U.
I understand that in proceeding with said photography or video the producer will do so in full reliance on
the foregoing permission. I also release all said rights to any comments or quotes, which may be used in
connection with corporate newsletters, industry publication, newspapers. I expressly agree to release
SEMI, Lower Columbia College, its members and agents, of any and all claims which I have or may have
for invasion of privacy, defamation, or any other causes of action arising out of production, distribution,
broadcast, exhibition or any other use whatsoever of photography, video or comments from students.
Yes No (If no, please talk to SEMI Rep. on day one so we do our best to keep you out of photos.)
RELEASE AGREEMENT:
I give my permission for my student to participate in SEMI High Tech U. I give permission to SEMI, Lower
Columbia College and the program sponsors to act on my behalf in the event of a medical emergency. I
hereby release, waive, and agree not to assert any claim of any sort, including claims, losses, or
damages on account of any injury, death or damage to property, against the SEMI Foundation, or any of
its members, partners, member firms, sponsors, advertisers, owners and lessees of any premises, or
volunteers participating in this event relating to any accident, event or mishap that occurs in connection
with my/my student's participation in the event. Yes No
AGREEMENT TO PARTICIPATE:
It is understood that if a student agrees to attend the SEMI High Tech U program, they will:
Attend all three days willingly
Agree to demonstrate the desired behaviors
Participate fully in all of the activities
___ Yes! I agree to display the desired behaviors and to participate fully in all the activities. ___ No, I
cannot agree to the above listed requirements. Explain:
My signature indicates my agreement with the conditions listed above.
Student Signature:
Date:
Parent/Guardian Signature (if Student is under 18):
Date:
If submitting electronically, your typed name, date, and email will be used in place of
signature.
Mail or e-mail application to Lower Columbia College, P.O. Box 3010, Longview, WA
98632; Attn: Hahli Rogers or email hrogers@lowercolumbia.edu.
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2019HTU Student Application (Lower Columbia College)

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Completed 27 July 2020

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