Project PAVE Student Intake

Student Information

School District / Grade
Address
Address
City
State/Province
Zip/Postal
Country
Gender
Demographic

Parent Information

Address
Address
City
State/Province
Zip/Postal
Country
Relation To Student
Address
Address
City
State/Province
Zip/Postal
Country
Relation To Student

Emergency Contact Information

STEM Interests – How interested are you in learning about: ( 4 = Definitely, 3 = Curious, 2 = Not so much, 1 = Not at all )

STEM Interests – How did you learn about Project PAVE?

Why do you want to be a part of Project PAVE?

Signatures and Consents

As a member of Cohort 4 – 2023-24, I understand that I am agreeing to actively participate fully in the 10 monthly Project PAVE sessions and other scheduled field trips, demonstrations and program activities.
By signature above, I consent to my child(ren) participating in the live and in-person Project PAVE sessions, chaperoned field trips and site visits, (and when available and approved) partner-provided mentorship sessions and summer internships, whether with MILLSTONE WEBER, LLC or our Project PAVE partners. It is understood and agreed that participation is purely voluntary, and my student may withdraw at any time upon 24 hour written notification to pjp@millstoneweber.com. INDEMNIFICATION WAIVER By signature above, I acknowledge that consent includes the use of photos, likenesses and/or or audio or visual media records related to MW and Project PAVE experiences. Further, in consideration of participation in the Project PAVE sessions, and on behalf of myself, my child(ren), my successors, representative and/or assigns (collectively “the releasing parties”), I indemnify and release Millstone Weber, LLC and any of its agents, associates, partners, officers or parties associated with Project PAVE from any and all liability claims, liens, actions or causes of action of any nature arising out of any damage, loss or injury to the releasing parties while participating in Project PAVE activities.
This student has been recruited, vetted and is recommended to join Project PAVE, a Millstone Weber STEM Initiative, based on demonstrated aptitude, ability and interest in pursuit of a career in engineering and/or construction.