Create GE Girls @ GT CEISMC Application

2017 Program is currently full for first-time participants.
Alumni are still encouraged to apply!

Who Should Apply? Middle school girls at East Cobb Middle School currently in 6th and 7th grade with an interest in science, math and technology. The camp is limited to 30 girls. Applicants will be selected based on a short essay and a teacher recommendation.

Transportation: Transportation provided to and from Georgia Tech for free. The bus will depart from and report back to the East Cobb Middle School. Students must be at the school, and picked up from the school, at the designated times. Cobb County Public Schools and GE staff will not be responsible for students who arrive earlier or later than the specified times. Students should plan to attend every day.

The program is funded by GE. Tuition is free. Attending the program is a privilege, and students are expected to be on their best behavior.

Questions: Contact Marisa Levy at marisa.levy@ceismc.gatech.edu

Before You Begin...

Thank you for your interest in applying for the GE Girls @ GA Tech program. This program is limited to students that have received an invitation to apply. Please review the form fields below and have the following information on hand when you begin the process:

  • Student's Personal Information
  • Student's School Name
  • Student's Emergency Contact Information
  • Student's Physician and Medical Information
  • Student Teacher Name and Email
  • A brief paragraph, written by the Student, about why they would like to attend a GE Girls @ Georgia Tech program.
Student Information
Adult Sizes
This field is Optional
Student Essay
Have the student write a brief essay about how they may benefit from the GE Girls @ GT CEISMC program.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Parent or Guardian Information
Recommendation and School Information
Enter the full name and email of a teacher that can provide a recommendation for this student.
Medical, Health, and Emergency Information
Release and Waiver Agreement

PARENTAL REQUEST TO PARTICIPATE RELEASE AND WAIVER AGREEMENT

I am the parent or legal guardian of the above-named Student/Participant and am requesting that my child enroll or participate in the following course, program, project, event, or activity (herein collectively referred to as Activity) being sponsored by or located on the campus of the Georgia Institute of Technology:

Name of Activity: GE Girls @ Georgia Tech 

Date of Activity: June 26th – June 30th, 2017

In consideration of permission being granted for my child to participate in this Activity and for other valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I am entering into this Release and Wavier Agreement, which extends to the following persons and entities, as well as their trustees, officers, directors, board members, agents, employees, volunteers, contractors, representatives, successors, or assigns, individually and in any capacity or relationship with or for any other:

  • Board of Regents of the University System of Georgia
  • Georgia Institute of Technology
  • Georgia Tech Student Government Association
  • Georgia Tech Research Corporation
  • General Electric

My childs enrollment or participation will or could subject my child to numerous dangers or risks of personal injury, even fatal, as well as other injuries or damages, including without limitation:

  1. major injuries such as: broken bones, cardiac arrest/heart attack, eye injury or loss of sight, drowning, concussion, joint, ligament or back injuries and heat exhaustion;
  2. minor injuries such as: strains, sprains, bruises, scratches, cuts and abrasions.

I have explained these risks to my child. These risks and dangers have been considered and, relying on my own judgment, I have voluntarily chosen to allow my child to participate and assume all such dangers and risks. I certify that my child is in suitable health and capacity which allows my childs enrollment or participation in the Activity.

I knowingly, voluntarily, and for adequate consideration release and waive, and further agree to indemnify, hold harmless, and reimburse each and all of those persons and entities referenced above, from an against any claim which I, my child, any other parent of my child, any relative or any next of kin of my child, or any other person, firm or corporation now or hereafter may have or claim to have (whether known or unknown, seen or unforeseen, directly or indirectly, or within or without the control of those persons and entities), for or on account of any losses, damages, personal injuries, pain and suffering, death, property damage, or contract claims resulting from, or arising out of, during, or in connection with my childs enrollment or participation in such Activity, or the ownership, operations, use, maintenance, or control of any vehicle, equipment or goods provided or used in connection with such Activity, or in any way connected with or arising out of instruction, training, emergency care, or operations incidental to such Activity. To the extent that any damages arising out of bodily injury to persons or damage to property are caused or result from the sole negligence of any person or entity referenced above, then, I do not agree to release, waive, indemnify, hold harmless or reimburse any such person or entity.

If any emergency medical procedures or treatment are required during the Activity, I consent to the Activity supervisor undertaking, arranging for or consenting to the procedures or treatment in his, her or their discretion and that I will be responsible for any and all expenses or fees related to my childs medical care. I acknowledge that neither Georgia Institute of Technology nor any of the above named entities shall be liable for any such fees or expenses under any circumstances.

Further, I hereby certify that my child is covered by an accident and health insurance policy that will be in effect at any time my child is participating in an Activity on the campus or, sponsored by, or related to the Georgia Institute of Technology.

In regard to any photographs, video tapes, motion pictures, recordings, or any other reproduction of my image or my childs image (hereinafter collectively known as Images) which Georgia Institute of Technology has taken of me or of my child or in which I may be included with others during the course of my participation in this program, I hereby grant to the Georgia Institute of Technology and to Georgia Tech Research Corporation permission to use such Images in any media now or hereafter known for any legitimate purpose whatsoever, and to use my name or my childs name in connection therewith if Georgia Institute of Technology and Georgia Tech Research Corporation so choose.

This Release and Waiver Agreement shall be construed to be as comprehensive as is allowed by law. Each provision herein is severable, so that should any provision or portion of such provision be held invalid, the remainder of this Release and Waiver Agreement shall not affect the enforceability of any other portion. This Release and Waiver Agreement shall not establish a legal or other relationship between or among those released which does not in fact exist. Nothing in this Release and Waiver Agreement shall constitute a waiver of any legal defense available to any released party herein, including sovereign immunity.

The validity, interpretation, and effect of the Release and Waiver Agreement shall be governed by the laws of the State of Georgia.

I CERTIFY THAT I AM 18 YEARS OF AGE OR OLDER AND THAT I AM SUFFERING FROM NO LEGAL DISABILITY. I HAVE READ AND UNDERSTAND THIS RELEASE AND WAIVER AGREEMENT.

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