* 1. Name

* 2. Gender

* 3. Are you a US Citizen?

* 4. Please specify your ethnicity.

* 5. Date of Birth

* 6. E-mail Address

* 7. Date of Application
(Example: 10/11/2013)

* 8. How did you learn about our research project?

* 9. Cell Phone Number

* 10. Landline Phone Number
(If you have one)

* 11. Mailing Address

* 12. Are you a first-generation college student?

* 13. Expected graduation date for bachelor degree

* 14. If you plan to graduate in the spring of 2014, what are your future plans for grad school? (Have/will apply ... where ... area of study)

* 15. Currently enrolled at what institution as a full-time student
(Name of institution and where it is located)

* 16. Current GPA

* 17. Statistical/Database programs with which you are familiar (e.g., R, SAS, SPSS, etc.)
Also indicate level of proficiency

* 18. Programming competency
C++, Java, PERL, R, etc.

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