Name:________________________________________________________________________________________
Address:______________________________________________________________________________________
E-mail:_____________________________________
Telephone Number
(___)______________________
Major______________________ Number of Credits Completed________ Grade Point Average___________
Expected
Graduation Date__________ Status:
Full-time/Part-time
U.S.
Citizen/Green Card Holder (Underline one)
Number
of Credits Registered for this Semester__________
Do
you plan to go to graduate school/medical school/other? If so, please indicate
which one, and what you plan to study.
List
science courses you are currently enrolled (please give course numbers and
titles).
List
college-level science courses you have completed and grades earned (please give
course numbers and titles, and where you took the course).
Describe
any research projects on which you are interested in working.
Where
did you hear about this program?
High
school_______________________ Location____________________
High
school diploma or GED (underline one) Year of high school degree__________
Employment
Experience
1.
Project yourself 15
years into the future and describe your work setting. Describe what you would
like to be doing for a living.
2.
Briefly describe your
academic strengths and weaknesses.