Marine Science Adventures

Student Applicant Information
*First Name
*Middle Name
*Last Name
Nickname
*Email Address
*Date of Birth
Country of Citizenship
*Male/Female
*Telephone
*Address
*City
*State
*ZIP
Passport Number
Passport Expiration Date	/ /

Parent/Guardian Information
*Mother's Name
*Home Phone
*Address
Place of Employment
*Email
Work Phone
*Father's Name
*Home Phone
*Address
*Email
Place of Employment
Work Phone
*Which parent is first point of contact?

Student Merit/Eligibility Information
*Do you have parent's approval to participate in the MANTA program?
*High School Name
*Grade
*Current GPA
*List of Science Courses Taken
*List of Extracurricular Activities?
*Do you intend to go to college?
*If so, what majors are you considering?
*Level of SCUBA certification (no experience necessary)
*If SCUBA certified, what was the certifying organization (e.g., PADI, NAUI)?
In 5 sentences or less, describe why you want to enroll in MANTA's program and what do you hope to gain from the experience?
A recommendation is necessary before acceptance into the MANTA program. While the MANTA program is a unique experience, it is physically, socially and academically challenging. Please identify a teacher that will provide a recommendation for you. We will contact them using the information you provide below and ask them to complete a short reference form.
Recommending Teacher Information
*Have you asked your teacher if they are willing to give you a recommendation (yes/no/not yet)?
*Teacher's Full Name
*Teachers's Affiliation (e.g., School Name)
*How do you know this teacher (e.g., biology teacher, sport's coach)?
*Teacher's Email