WelcomeMathematics, Engineering, Science Achievement (MESA) Mathematics, Engineering, Science Achievement (MESA) is a school-based outreach program designed to increase access to Science Technology Engineering and Mathematics (STEM) pathways and encourage college readiness for low-income, minority or first-generation collegebound students in grades 6-12. Please complete the registration form to participate in the program. Loading...If you have already completed your MESA program application for this school year, you do not need to complete this form. Please contact us at azmesa@email.arizona.edu with any questions.Your Information - Su InformaciónWho is completing the registration form? ¿Quién completa el formulario de registro?Who is completing the registration form? ¿Quién completa el formulario de registro?The student who will be participating in the program. / El estudiante que participará en el programa.A parent or legal guardian of the student. / Un padre o tutor legal del estudiante.¿Prefiere recibir comunicaciones de MESA en español? Do you prefer to receive MESA communications in Spanish?¿Prefiere recibir comunicaciones de MESA en español? Do you prefer to receive MESA communications in Spanish?YesNoYour First Name Su NombreYour Last Name Su ApellidoYour Email Su Correo ElectrónicoCheck this box if you do not have an email address:Check this box if you do not have an email address:I do not have an email address. Please contact me by phone with the event and registration details.Marque esta casilla si no tiene una dirección de correo electrónico:Marque esta casilla si no tiene una dirección de correo electrónico:No tengo una dirección de correo electrónico. Por favor contácteme por teléfono con el evento y los detalles de registro.Your Phone Su Número de TeléfonoYour Relation to Student Su Relación con el EstudianteMotherFatherLegal GuardianStep-MotherStep-FatherStudent's Information - Información del EstudianteStudent's First Name Nombre del EstudianteStudent's Last Name Apellido del EstudianteStudent's Preferred First Name (optional) Nombre Preferido del Estudiante (no requerido)Student's Gender Identity Identidad de Género del EstudianteFemale/WomanMale/ManTrans WomanTrans ManGenderqueer/Gender FluidNonbinaryAgenderQuestioningI identify with more than one of these optionsPrefer not to answerStudent's Ethnicity - Please select all that apply Etnicidad del Estudiante - seleccione todas las que correspondanStudent's Ethnicity - Please select all that apply Etnicidad del Estudiante - seleccione todas las que correspondanAmerican Indian or Alaska NativeAsianBlack or African AmericanHispanic/LatinxNative Hawaiian or Other Pacific IslanderWhiteStudent's Birthdate Fecha de Nacimiento del EstudianteStudent's Birthdate Fecha de Nacimiento del EstudianteJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Student's Email (optional) E-mail del Estudiante (no requerido)Parent/Guardian's Phone Número de Teléfono de los PadresParent/Guardian's Email E-mail de los PadresCheck this box if your parent/guardian does not have an email address:Check this box if your parent/guardian does not have an email address:My parent does not have an email address. Please contact them by phone with the event and registration details.Marque esta casilla si su padre no tiene una dirección de correo electrónico:Marque esta casilla si su padre no tiene una dirección de correo electrónico:Mi padre no tiene una dirección de correo electrónico. Comuníquese con ellos por teléfono con el evento y los detalles de registro.Student's Mailing Address Dirección Postal del EstudianteStudent's Mailing Address Dirección Postal del EstudianteCountryStreetCityRegionPostal CodeAlgebra AcademyCollege Academy for ParentsCollege Knowledge for ParentsEAO (General)MESANASEPAdmitApplicantParticipantWithdrawnWhat is the student's grade level? ¿Cuál es el nivel de grado del estudiante?06070809101112ElementaryWhat is the name of the school the student attended this year? ¿Cuál es el nombre de la escuela a la que asistió el estudiante este año? If your school is not listed, please contact eao@arizona.edu.*School Not Listed*Academia Del PuebloAlhambra High SchoolAlhambra TraditionalAlice Vail Middle SchoolAlta Loma High SchoolAlta Vista High SchoolAmor Dei Academy - HSAmor Dei Academy - MSAmphitheater High SchoolAmphitheater High School Personalized Alternative Track High School Program (PATH)Amphitheater Middle SchoolAndalucia Middle SchoolAnna E. Lawrence 3-8 SchoolApache Junction High SchoolApollo Middle SchoolArizona K-8 Online AcademyArizona School for the Deaf and BlindArthur M Hamilton ElementaryASU QESSTBaboquivari High SchoolBaboquivari Middle SchoolBarcelona Elementary SchoolBarcelona Middle SchoolBilly Lane Lauffer Middle SchoolBourgade Catholic High SchoolC.E. RoseCactus High SchoolCalabasas MSCarl Hayden High SchoolCarol G Peck SchoolCarson Junior HighCartwright SchoolCasa Grande Middle SchoolCatalina Magnet High SchoolCatalina VenturaCentral High SchoolCesar Chavez High SchoolChallenger Middle School (Glendale)Challenger Middle School (Tucson)Changemaker High SchoolChaparral Junior High SchoolCharles W Harris Elementary SchoolCheathem ElementaryChiawana High SchoolChoice Learning AcademyCibola High SchoolCity High SchoolCity View High SchoolCollier ElementaryCopper State AcademyCordova Elementary SchoolCordova Middle SchoolCosta Mesa High SchoolCountry PlaceCraycroft Elementary SchoolDeer Valley Middle SchoolDesert MeadowsDesert Oasis ElementaryDesert Sands Middle SchoolDesert ShadowsDesert View High SchoolDodge Traditional Magnet SchoolDon MensendickDoolen Middle SchoolDrexel Elementary SchoolDunbar ElementaryDunloggin Middle SchoolEllicott Mills Middle SchoolElvira Elementary SchoolEsperanza Elementary SchoolEstrella Foothills High SchoolEstrella Middle SchoolEstrella VistaFine Arts AcademyFlowing Wells High SchoolFlowing Wells Junior High SchoolFrank Borman ElementaryFreedom Elementary SchoolFremont Junior High SchoolGallego Intermediate 4-8 Fine Arts Magnet SchoolGallego Primary Fine Arts Magnet SchoolGarfield Elementary SchoolGarfield SchoolGila Ridge High SchoolGirls Innovation AcademyGirls Leadership Academy of ArizonaGlenn L. DownsGlobal Academy of PhoenixGranada East SchoolsGregory SchoolHasan Preparatory and Leadership SchoolHayden High SchoolHighland PrepHoliday Park Elementary SchoolHollinger K-8Hope High SchoolIndian Oasis Intermediate SchoolIronwood High SchoolJames W. RiceJustine Spitalny STE³AM SchoolKino Junior High SchoolLa Cima Middle SchoolLaveen ElementaryLeodis V. McDaniel High SchoolLiberty Elementary SchoolLiberty High SchoolLittleton ElementaryLos Amigos Elementary SchoolLos Niños Elementary SchoolLowell SchoolM.C. Cash ElementaryMadge Utterback Middle SchoolMadrid Neighborhood SchoolMaie Bartlett Heard SchoolMarana High SchoolMarc T. Atkinson Middle School and Gifted AcademyMaricopa Institute of TechnologyMcClintock High SchoolMetro Tech High SchoolMission Manor Elementary SchoolMontebello Middle SchoolMountainside Middle SchoolNewell Barney Junior High SchoolNex+Gen AcademyNogales High SchoolNorth High SchoolNorthern High SchoolNosotros AcademyOak Creek SchoolOasis Elementary SchoolOcotillo Learning CenterPalo Verde High Magnet SchoolParkrose Middle SchoolPaseo PointePeoria High SchoolPeoria Junior MESAPhoenix Christian Junior-Senior High SchoolPhoenix Christian Preparatory School - MSPhoenix Coding AcademyPhoenix Union Bioscience High SchoolPistor Middle SchoolPorfirio Gonzalez ElementaryPueblo Gardens PreK-8 SchoolPueblo Magnet High SchoolQueen Creek Junior HighQuentin Elementary SchoolQuentin STEM AcademyR. E. Simpson SchoolRaúl H. Castro Academy of Fine ArtsReynolds Middle SchoolRichard B. Wilson K-8 SchoolRidgeview College Preparatory High SchoolRincon High SchoolRio Rico High SchoolRio Vista ElementaryRivera Elementary SchoolRoberts Naylor Tucson K-8Rogers Ranch ElementaryRoskruge Bilingual K-8Round Valley Middle SchoolSafford K-8Sahuarita High SchoolSanta Clara Elementary SchoolSanta Fe ElementarySanta Rita High SchoolSevilla West SchoolShadow Mountain High SchoolSheely Farms ElementaryShepherd Junior HighSierra 2-8Silvestre S Herrera SchoolSkyline High SchoolSmith Junior High SchoolSonoran Science AcademySonoran Science AcademySouth Pointe High SchoolSt John the EvangelistSt. Michaels Indian SchoolStar Academic High SchoolSummit View Elementary SchoolSun Valley AcademySunnyside High SchoolTaylor Junior HighTempe Elementary Online AcademyThe Science Vortex - CottonwoodThunderbird High SchoolTrailside Point Elementary SchoolTres Rios ElementaryTrevor G Browne High SchoolTucson Magnet High SchoolUplift Wisdom Preparatory SchoolValencia Middle SchoolValencia Newcomer SchoolValley View ElementaryVerde Tech High SchoolVista Del Sur Accelerated AcademyVista Verde Middle SchoolWade Carpenter Middle SchoolWalden Grove High SchoolWestwood High SchoolWillis Junior High SchoolWrightson Ridge K-8 School//Hidden field to collect EAO Entity Value GROUP 10 for current Program Year - defaults to current date//hidden field for GROUP 10 EAO entity identity (program-grade-school)When will the student enroll in college? ¿Cuándo se matriculará el estudiante en la universidad?Fall 2024Spring 2025Fall 2025Spring 2026Fall 2026Spring 2027Fall 2027Spring 2028Fall 2028Spring 2029Fall 2029Spring 2030Fall 2030Spring 2031Fall 2031Spring 2032Fall 2032Spring 2033Fall 2033Spring 2034Fall 2034Spring 2035Fall 2035First-YearTransferReadmitNon-Degree SeekingTransfer Readmit AlumniStudent's T-Shirt Size Talla de Camiseta de EstudianteAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLDid the student participate in MESA in previous years? ¿Participó el estudiante en MESA en años anteriores?Did the student participate in MESA in previous years? ¿Participó el estudiante en MESA en años anteriores?YesNoPrevious MESA ParticipationDeleteProgram Year _ID_Algebra AcademyCollege Academy for ParentsCollege Knowledge for ParentsEAO (General)MESANASEPStudent's Grade Level: Nivel de grado del estudiante:06070809101112ElementaryProgram Start Date: Fecha de inicio del programa:Program Start Date: Fecha de inicio del programa:JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044Enter a Participation YearFamily Information - Información de la FamiliaDoes the student qualify for or receive free or reduced lunch? ¿El estudiante califica o recibe almuerzo gratis o reducido?Does the student qualify for or receive free or reduced lunch? ¿El estudiante califica o recibe almuerzo gratis o reducido?NoNot ApplicableUnsureYesTotal number of people living in the household? ¿Número total de personas que viven en el hogar?Annual Household Income (Information will be used for statistical purposes only): Ingreso anual del hogar (la información se utilizará únicamente con fines estadísticos):0-25,00025,001-35,00035,001-40,00040,001-45,00045,001-50,00050,001-55,00055,001-60,00060,001+Prefer not to answerDid either of the student's parents graduate from a 4-year college or university? ¿Alguno de los padres del estudiante se graduó de un colegio o universidad de 4 años?Did either of the student's parents graduate from a 4-year college or university? ¿Alguno de los padres del estudiante se graduó de un colegio o universidad de 4 años?YesNoStudent Agreement - Acuerdo EstudiantilI will actively participate in MESA and will pursue a path to college. I grant access to my school records for the purpose of generating reports. I understand my name will not be used in any such reports. I grant MESA and/or other partners’ permission to utilize all photographs/video/audio of myself and quotes from myself for purpose of illustrations, advertising, media use or publications in any manner.Participaré activamente en MESA y seguiré un camino hacia la universidad. Otorgo acceso a mis registros escolares con el fin de generar informes. Entiendo que mi nombre no se utilizará en dichos informes. Doy permiso a MESA y / o a otros socios para utilizar todas las fotografías / videos / audio de mí mismo y citas mías con el propósito de ilustraciones, publicidad, uso de medios o publicaciones de cualquier manera.* By checking this box and typing my name below, I am electronically signing my application.* Al marcar esta casilla y escribir mi nombre a continuación, estoy firmando electrónicamente mi solicitud.Type in your name: Escriba su nombre:Parent/Guardian Agreement - Acuerdo de los PadresI will support my student’s involvement in MESA and on their path to college. I grant access to my student’s school records for reporting purposes and understand my child’s name will not be used in these reports. I grant MESA and/or other partners’ permission to utilize all photographs/video/audio of myself or my child and quotes from myself or my child for purpose of illustrations, advertising, media use or publications in any manner.Apoyaré la participación de mi estudiante en MESA y en su camino hacia la universidad. Doy acceso a los registros escolares de mi hijo para fines de informes y entiendo que el nombre de mi hijo no se utilizará en estos informes. Doy permiso a MESA y / o a otros socios para utilizar todas las fotografías / videos / audio de mí o de mi hijo y citas mías o de mi hijo con el propósito de ilustraciones, publicidad, uso de medios o publicaciones de cualquier manera.* By checking this box and typing my name below, I am electronically signing this application.My parent is not available. Please contact them for their signature.* Al marcar esta casilla y escribir mi nombre a continuación, estoy firmando electrónicamente esta solicitud.Mi padre no está disponible. Por favor contáctelos para su firma.Type in your name: Escriba su nombre:Additional Registration - Registro AdicionalWould you like to register any other family members with the University of Arizona? ¿Le gustaría registrar a otros miembros de la familia en la Universidad de Arizona?Would you like to register any other family members with the University of Arizona? ¿Le gustaría registrar a otros miembros de la familia en la Universidad de Arizona?Yes/SiNoHow many family members would you like to register? ¿Cuántos miembros de la familia te gustaría matricular?1234Family Member 1 - Relation to Student Miembro de la Familia 1 - Relación con el EstudianteMotherFatherLegal GuardianStep-MotherStep-FatherSisterBrotherFamily Member 1 - First Name Miembro de la Familia 1 - NombreFamily Member 1 - Last Name Miembro de la Familia 1 - ApellidoFamily Member 1 - Birthdate (optional) Miembro de la Familia 1 - Fecha de Nacimiento (no requerido)Family Member 1 - Birthdate (optional) Miembro de la Familia 1 - Fecha de Nacimiento (no requerido)JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Family Member 1 - Email (optional) Miembro de la Familia 1 - Correo Electrónico (no requerido)Family Member 1 - Current Grade LevelNot in SchoolPre-KK010203040506070809101112Family Member 1 - Current SchoolFamily Member 1 - T-Shirt SizeAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLFamily Member 2 - Relation to Student Miembro de la Familia 2 - Relación con el EstudianteMotherFatherLegal GuardianStep-MotherStep-FatherSisterBrotherFamily Member 2 - First Name Miembro de la Familia 2 - NombreFamily Member 2 - Last Name Miembro de la Familia 2 - ApellidoFamily Member 2 - Birthdate (optional) Miembro de la Familia 2 - Fecha de Nacimiento (no requerido)Family Member 2 - Birthdate (optional) Miembro de la Familia 2 - Fecha de Nacimiento (no requerido)JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Family Member 2 - Email (optional) Miembro de la Familia 2 - Correo Electrónico (no requerido)Family Member 2 - Current Grade LevelNot in SchoolPre-KK010203040506070809101112Family Member 2 - Current SchoolFamily Member 2 - T-Shirt SizeAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLFamily Member 3 - Relation to Student Miembro de la Familia 3 - Relación con el EstudianteMotherFatherLegal GuardianStep-MotherStep-FatherSisterBrotherFamily Member 3 - First Name Miembro de la Familia 3 - NombreFamily Member 3 - Last Name Miembro de la Familia 3 - ApellidoFamily Member 3 - Birthdate (optional) Miembro de la Familia 3 - Fecha de Nacimiento (no requerido)Family Member 3 - Birthdate (optional) Miembro de la Familia 3 - Fecha de Nacimiento (no requerido)JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Family Member 3 - Email (optional) Miembro de la Familia 3 - Correo Electrónico (no requerido)Family Member 3 - Current Grade LevelNot in SchoolPre-KK010203040506070809101112Family Member 3 - Current SchoolFamily Member 3 - T-Shirt SizeAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLFamily Member 4 - Relation to Student Miembro de la Familia 4 - Relación con el EstudianteMotherFatherLegal GuardianStep-MotherStep-FatherSisterBrotherFamily Member 4 - First Name Miembro de la Familia 4 - NombreFamily Member 4 - Last Name Miembro de la Familia 4 - ApellidoFamily Member 4 - Birthdate (optional) Miembro de la Familia 4 - Fecha de Nacimiento (no requerido)Family Member 4 - Birthdate (optional) Miembro de la Familia 4 - Fecha de Nacimiento (no requerido)JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Family Member 4 - Email (optional) Miembro de la Familia 4 - Correo Electrónico (no requerido)Family Member 4 - Current Grade LevelNot in SchoolPre-KK010203040506070809101112Family Member 4 - Current SchoolFamily Member 4 - T-Shirt SizeAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLSubmit
