Submission Deadline: Friday, April 13, 2012

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* 1. Student First Name

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* 2. Student Middle Initial

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* 3. Student Last Name

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* 4. Student Street Address

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* 5. Student City

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* 6. Student Zip

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* 7. Student E-mail

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* 8. Student Cell Phone (xxx) xxx-xxxx

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* 9. Parent/Guardian Name

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* 10. Parent/Guardian E-mail

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* 11. Parent/Guardian Phone (xxx) xxx-xxxx

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* 12. Name of teacher nominating you

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* 13. High School/College

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* 14. School City

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* 15. County

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* 16. Minority Category (check one)

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* 17. 2011-12 School Status/ Grade (check one)

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* 18. Gender

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* 19. Cumulative GPA

Exam Scores

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* 20. PSAT (high school students only)

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* 21. SAT

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* 22. ACT

Important: Send a copy of your school transcript and your exam score report, unless these scores are on your transcript.

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* 23. Please check if you have participated in either of the following:

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* 24. Are you eligible to receive free/reduced lunches at your school (high school only)?

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* 25. Have you discussed this opportunity, the registration fee, and need for transportation to and from the program with your parent(s) or guardian?

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* 26. Is anyone in your immediate family a Certified Public Accountant?

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* 27. Please list the business, accounting, and math classes that you have taken.

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* 28. Please list your extra-curricular activities, any honors or awards you have received, and volunteer/employment history.
Indicate year(s) in parentheses (like 11-12).

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* 29. What do you enjoy doing in your spare time?

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* 30. What college major(s) are you considering or pursuing right now?

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* 31. What are your top two choices for where you would like to go to college?

Short Essay
Please respond to the following questions.

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* 32. What do you think of when you hear the words “Certified Public Accountant? (150 word limit)

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* 33. If you owned your own business, what aspect of running it would present the greatest challenge to you? (200 word limit)

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* 34. Why do you feel attending the Minority Summer Residency Program would be beneficial to you? (300 word limit)

Student Declaration

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* 35. I submit this application to attend the Minority Summer Residency Program scheduled for June 10-14, 2012 at the University of South Florida in Tampa and will regularly monitor my email (at addresses I’ve provided in this application), for communications from the Florida Institute of CPAs. If selected to participate, I agree to pay the $75 registration fee (unless eligible for a scholarship).

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