Mesa Verde Middle School Robotics Club

Application Form
Student name(please print)__________________________
Grade____ Homeroom Teacher_______________________ AM/PM/NA
Do you want to participate in robotics competitively? If so, why?
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Do you have any prior experience in a robotics team? If so, what did you partake in?
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Explain, in your own words, what Gracious Professionalism means.
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Do you have any prior programming experience? If so, what language?
_____________________________________________________________________________
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Do you have any experience in building robots? If so, what platform?
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Would you be willing to help with fundraising for the club? What ideas do you have
for fundraising?
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How much time a week are you willing to devote to robotics?
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Remember that the officers of the club reserve the right to remove anybody from the
competitive division of the club if they feel that the member is a disturbance to the club or is
not keeping up with academics in a satisfactory manner.

Student Signature ______________________________Date___________

I acknowledge that this student, to the best of my knowledge, is hardworking and
responsible.
Teacher Signature_______________________________ Date___________
Teacher Signature_______________________________ Date___________
I hereby allow my child to participate in the robotics club at Mesa Verde.
Parent Signature________________________________ Date___________