Summer Camp:
July 12-18, 2009

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IAI: Application Form

Applications must be postmarked by April 15. Enrollment is limited, so register early.

Fill out, Print, and Mail to:

Diane Jeffers
306 Talbot Lab
104 South Wright Street
Urbana, IL 61801

Along with this form remember to submit:

List of coursework in math and science, including grades
Letter of recommendation from a math or science teacher
Letter describing your interest and experiences in astronomy, aviation or aerospace
$100 deposit

First Name:	Middle Name:	Last Name:	Age:

Gender:	Present Grade:	Email Address:
Male Female	8 9 10 11
Name of School:

Name of Parent/Guardian

Address of Parent/Guardian

City		State	Zip

Parent/Guardian Home Phone		Parent/Guardian Work Phone
- -		- -
Please send me information on financial aid