Wentworth Innovation Scholars Program Referral Form

We invite you to nominate students for the Innovation Scholars Program. Benefits include joining a Living Learning Community, a summer research stipend plus free room and board the summer after First Year.

The following programs are eligible: Applied Mathematics, Applied Science, Biological Engineering, Biomedical Engineering, Business Management, Computer Information, Systems Computer Science & Society, Construction Management, Data Science, Industrial Design, Information Technology, and Interior Design

Student Information: Personal (starred * fields are required)

Last Name*

First Name*

Middle Name

Email Address*

Birthdate*

Why is date of birth required?
We use the date of birth to help us identify individuals, to correctly match people with their data, and to keep information about different people with the same name separate.

Student Information: Academic

Anticipated Start Term

First year or transfer?

Please provide the name of the student's high school. You can type the city or town in the field below, and then select the school from the list.

Information About You

First Name*

Last Name*

Email Address*

Do you work at a high school?

Yes

No

Please provide the name of the high school. You can type the city or town in the field below, and then select the school from the list.*

What is your role*

Are you an independent counselor?

Yes

No

What is your relationship to the student?