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Home > College Preparation Workshop Series > Application
College Preparation Workshop Series Application
Overview Online Application Consent & Release Form: Word | PDF

Application Deadline: Monday June 1, 2009

Section 1: Student Information Form
Student Name:
(First, M.I., Last)
Date of Birth:
Home Address:
City:
State:
Zip Code:
Phone Number:
Email Address:
Gender:
(optional)
 Male    Female
Ethnic Group:
(optional)

Black/African American/West Indian
Latina/o or Hispanic
Native American or Alaskan Native
Caucasian
Asian or Pacific Islander
Other (specify)

EDUCATIONAL BACKGROUND AND INTERESTS
Name of High School:
High School Address:
City:
State:
Zip Code:
Current Grade:
(i.e. 10th)
Overall GPA:
(on 4.0 scale)
High School Major/Track:
SAT Scores: (if taken)
Math:
Critical Reading:
Writing:

Math, Science and Technical Courses:
Please list the courses you have completed or are in the process of completing. Include the approximate letter grade earned if you have completed the course (e.g. A, B-).

Math Courses Letter Grade

Science Courses Letter Grade

Technology or Engineering Courses Letter Grade
 

What majors you are considering for college?
 

What colleges or universities you are interested in attending?
 

What jobs or careers are you considering once you graduate from college?
 

Which of the following disciplines do you find most interesting?
(Check all that apply)

Astronomy
Biology
Chemistry
Computer Science
Economics
Engineering
Geology & Earth Sciences
Medical & Health Sciences
Physics
Mathematics
Statistics
Other (specify)

  Teacher Reference:
Please provide the name and contact information of a math, science or technology teacher who can speak about your academic and extra-curricular accomplishments.

Teacher's Name:
Course(s) Taught:
Work Phone:
Email Address:

Section 2: Personal Statement

Personal Statement
Write at least a 500-word essay to answer these questions:
(1) Why do you think it is important to attend college?
(2) Why should you be chosen as a CPWS participant and what do you hope to learn from the workshop?
(3) What are your educational and career goals? How could CPWS impact your educational and career goals?

Use the space provided below. You can type it in Microsoft Word and copy and paste it in the space below.

 

By submitting this application, I am indicating that all information provided is accurate, and any misrepresentation of this information will be cause for my disqualification from consideration for this program. I also understand that if selected to participate in the College Preparation Workshop Series that I must participate for the duration of the workshop. Failure to meet these requirements will cause my immediate termination from the program.