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__________
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.