2026 STEM Academy

Student Information

First Name

Last Name

Birthdate

Email Address

Cell Phone Number

Will you need a parking permit to park on campus during the Academy?

Yes

No

Academic Information

Which grade will you be in for the upcoming 2026-27 school year?

9th Grade

10th Grade

11th Grade

12th Grade

High School You're Attending in 2026-27

Your School District in 2026-27

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email Address

Required Documents

Release of Liability
Please follow the link to review the release of liability form. Upon review, please sign, date, and upload the form. Participants under the age of 18 must have the form signed by a legal parent or guardian.

In addition to uploading the signed Release of Liability form, please confirm your acknowledgment below.

Check below to acknowledge that you (or your parent/guardian, if under 18) acknowledge and accept the terms outlined in the Release of Liability form for participation in this program?

In addition to uploading the signed Release of Liability form, please confirm your acknowledgment below.

Check below to acknowledge that you (or your parent/guardian, if under 18) acknowledge and accept the terms outlined in the Release of Liability form for participation in this program?

Yes, I acknowledge and accept the terms.

Medical Authorization Form
Please follow the link to review the medical authorization form. Upon review, please sign, date, and upload the form. Participants under the age of 18 must have the form signed by a legal parent or guardian.

If yes, please list the medication(s), dosage, and any special instructions or considerations (e.g., refrigeration, timing):

Note:This information will be kept confidential and is only used to ensure your safety and well-being during the program. Our staff is not authorized to administer medications but may assist with reminders if needed.

Current Medications
Are you currently taking any medications that we should be aware of during the program (e.g., for allergies, asthma, etc.)?

Yes

No

Visual/Audio Image Release Form
Please follow the link to review the visual/audio image release form. Upon review, please sign, date, and upload the form. Participants under the age of 18 must have the form signed by a legal parent or guardian.

In addition to uploading the signed Visual/Audio Image Release Form, please confirm your consent below.

Do you (or your parent/guardian if under 18) give Cal Poly Pomona permission to use photographs or videos of you taken during this program for promotional purposes?

In addition to uploading the signed Visual/Audio Image Release Form, please confirm your consent below.

Do you (or your parent/guardian if under 18) give Cal Poly Pomona permission to use photographs or videos of you taken during this program for promotional purposes?

Yes, I give consent.

No, I do not give consent.

Summer Program Expectations

Summer Program Expectations
Our goal is to create a safe, fun, and welcoming place where everyone can learn, make friends, and try new activities. To help make the summer program a great experience for everyone, please review the expectations below with your parent/guardian.

Be kind and respectful, including respecting people’s personal space, belongings and University.
Listen attentively, use appropriate language, engage in academic activities, and follow safety instructions.
Remain focused and on task during program time and activities
Not Allowed in the Program
Weapons, drugs, alcohol, or other prohibited items.
Fighting, roughhousing, touching others, bullying or unsafe behavior.
Students who are unable to follow program expectations or participate safely in activities may be asked to leave the program.

Summer Program Expectations
Our goal is to create a safe, fun, and welcoming place where everyone can learn, make friends, and try new activities. To help make the summer program a great experience for everyone, please review the expectations below with your parent/guardian.

Be kind and respectful, including respecting people’s personal space, belongings and University.
Listen attentively, use appropriate language, engage in academic activities, and follow safety instructions.
Remain focused and on task during program time and activities
Not Allowed in the Program
Weapons, drugs, alcohol, or other prohibited items.
Fighting, roughhousing, touching others, bullying or unsafe behavior.
Students who are unable to follow program expectations or participate safely in activities may be asked to leave the program.

I understand.

Program Availability

I have verified that I can attend the entire program daily from 7:30 a.m. to 4 p.m., and that the dates may not be modified.

2026 STEM Academy

July 13-17 at Cal Poly Pomona
Daily 7:30 a.m. to 4 p.m.

Commitment Requirement

Who Should Apply

FAQs

Contact Us

2026 STEM Academy

July 13-17 at Cal Poly Pomona Daily 7:30 a.m. to 4 p.m.

Commitment Requirement

Who Should Apply

FAQs

Contact Us

July 13-17 at Cal Poly Pomona
Daily 7:30 a.m. to 4 p.m.