*Name: (Last, First, Middle)

*E-mail Address:

*Street Address:

*City

*State

*Zip Code:

*University I.D. Number:

*Local Phone Number:

Permanent Phone Number:

*Primary Major:

Second Major

*Expected Graduation Date:

*College Grade Point Average:

*Are you the first in your immediate family to enroll in a degree-seeking program at a four-year institution?
Yes No

*A FAFSA form is required for need-based aid.
Do you have a FAFSA form on file with the University of Maryland Office of Financial Aid?
Yes No

WORK EXPERIENCE

Current Place of Employment:

Supervisor:

Hourly Rate:

Number of hours worked, per week, during the semester:

Approximate amount earned during the semester:

Do you anticipate that your work commitment will be the same next year?
Yes No

*Please provide the following information: Internships, research and work experiences, co-curricular activities, professional activities and memberships, honors and awards, and community service. You may copy and paste from your resume.

*ALSO PROVIDE NAMES, TITLES, ADDRESSES, AND PHONE NUMBERS OF TWO REFERENCES. ONE SHOULD SERVE AS A PERSONAL REFERENCE AND ONE MUST BE A CMPS FACULTY MEMBER.

*STUDENT STATEMENT: Please enter a statement describing your career plans, financial considerations affecting your ability to attend the University, and other pertinent information that would be helpful in assessing your application. Please limit your statement to no more than one double-spaced pages using a 12-point font. You may want to type your statement using a word processing program then copy and paste into the box below