National Grid UB School of Engineering Leadership Camp
Welcome, student from  
User Name
Street Address
Zip Code
Phone Number
Date of Birth
Gender Female Male
(Optional) Black Hispanic Asian Native American Caucasian Other
Grade completed
this year 9th 10th
Name of
current school
Nominated by
Grade Point
List all high school math and science courses in which you are currently enrolled
or have completed.
Enter your average grade for each course in which you are currently enrolled and
enter your final grade for the courses that you have completed.
Course NameFinal Grade
Add another course
List any honors, awards, and /or special recognitions
Add another honor, award or special recognition
List your extra-curricular activities
Add another extra-curricular activity
List your interests and hobbies
Add another interest
Please indicate your career goals and state how you would benefit from this program:
Name of parents
or guardians
The address of my parents/guardians is the same as mine
Street Address
ZIP code
Home Phone No.
Work Phone No.
Cell Phone No.
Cell Phone No.
Email Address
Email Address
Parent's Highest Degree of Education
Some HS
Some College
Masters or higher
I prefer not to answer
Answers to this question will not influence the selection of candidates to participate in the camp.
Cost of program to student: $60 non-refundable deposit.
The deposit must accompany the submission of the required paperwork.
There are a limited number of scholarships for students for whom the financial cost of attending the camp would constitute a hardship.
Please contact Steven Pilat, Camp Coordinator, at for more information.
I understand that by accepting this invitation to participate in this Leadership Camp that I am acknowledging that, should I be accepted into the program, I will attend all classes and I will follow the math/science curriculum. In addition, I authorize the school that I attend to release and/or verify the accuracy of my grade reports. I also acknowledge that to receive a UB engineering scholarship*** and certificate I must complete the program.
Thank you very much for applying to the National Grid/UB Engineering 2018 Leadership Camp !!!
The selection process will be completed by the end of May and those selected will be notified of the registration process at that time.
Your camp application identifier is  
An email has receipt has been sent to  . This email includes your application identifier.
Please keep that email for your records and always include this identifier on all correspondence related to your application.
Please also contact the National Grid/UB Engineering Leadership Camp staff at 
if you have any questions or if you require assistance.
Contact the National Grid/UB Engineering Leadership Camp Staff :
Technical Problems ? Contact the support staff at :