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* 1. Name

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* 2. Gender

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* 3. Are you a US Citizen?

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* 4. Please specify your ethnicity.

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* 5. Date of Birth

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* 6. E-mail Address

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* 7. Date of Application
(Example: 10/11/2014)

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

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* 9. Cell Phone Number

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

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* 11. Mailing Address - INCLUDE CITY & STATE

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

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* 13. Expected graduation date for bachelor degree

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* 14. If you plan to graduate in the spring of 2015, what are your future plans for grad school? (Have/will apply ... where ... area of study)

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

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* 16. Current GPA

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

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

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