Jump Start 2015 Program Application

Sponsored by the College of Computer, Mathematical, and Natural Sciences, University of Maryland through a grant from the Howard Hughes Medical Institute Undergraduate Science Education Program

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* 1. Contact Information

Name

Address:

City/Town:

State:

ZIP/Postal Code:

Email Address:

Phone Number:

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* 2. Birth Date:

Date

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* 3. Sex

Male

Female

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* 4. Please check the appropriate boxes below: The information on this item is requested solely for the purpose of determining compliance with federal civil rights laws. Your response is completely voluntary and will not affect consideration of your application. By providing this information, you will assist in assuring that this program is administered in a nondiscriminatory manner.

American Indian

Asian or Pacific Islander

White

Black

Hispanic

Other

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* 5.

Most recent High School attended

Cumulative Grade Point Average (GPA)

PSAT (If available)

SAT (If available)

ACT (if available)

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* 6. Projected year of graduation from high school

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* 7. Preferred Session (Select ONLY ONE)

Session 1 - Biomedical Science (July 20-24)

Session 2 - Biomedical Science (July 27-31)

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* 8. Check all that apply

I wish to have my name, place of residence,phone number and email address distributed to other participants in my session to facilitate carpooling.

I have special dietary requirements for the closing luncheon (e.g., kosher, vegan, etc.). Please note that the luncheon buffet will include vegetarian options.

Special dietary requirements

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* 9. Personal statement (choose only one):

In no more than 1000 words, describe a person or pivotal event that helped define your interest in science.

or

In no more than 1000 words, tell us about something that stimulates your curiosity. Where has your curiosity led you?

Additional application materials (must be post marked by March 15, 2015)

High school transcript (unofficial photocopy is acceptable)
Courses in progress and semester grades (if not included on transcript)
Letter of recommendation from a teacher (science teacher preferred, but not required)
Mail additional application materials to :

Dr. Kaci Thompson

Jump Start Program
1313 Symons Hall
College of Computer, Mathematical, and Natural Sciences
University of Maryland
College Park, MD 20742

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* 1. Contact Information

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* 2. Birth Date:

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* 3. Sex

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* 5.

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* 6. Projected year of graduation from high school

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* 7. Preferred Session (Select ONLY ONE)

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* 8. Check all that apply

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* 9. Personal statement (choose only one):In no more than 1000 words, describe a person or pivotal event that helped define your interest in science.orIn no more than 1000 words, tell us about something that stimulates your curiosity. Where has your curiosity led you?

* 9. Personal statement (choose only one):

In no more than 1000 words, describe a person or pivotal event that helped define your interest in science.

or

In no more than 1000 words, tell us about something that stimulates your curiosity. Where has your curiosity led you?