RICE UNIVERSITY PROJECT GRAD ADVANCED SUMMER MATHEMATICS ACADEMY by kse10139

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									    RICE UNIVERSITY PROJECT GRAD ADVANCED SUMMER MATHEMATICS
                              ACADEMY
                      STUDENT APPLICATION FORM


Student Name: _________________________________________________________________________
                       Last                        First                 Middle Initial

Date of Birth: ______________                               Student ID #: ________________________
                 Month Date Year

Address: _____________________________________________________________________________
                       Street Address                                           Apt #

           ___________________________________________________________________________
                       City                         State                 Zip Code

Phone Number: ___(_______)_________________________________
                      Area Code             Number

Project GRAD High School: ____________________________________________________________

Classification:   Freshman         Sophomore       Junior    Senior

Grade Point Average: ______________               High School Graduation Date: ______________

Summer Academy Class:        GEOMETRY          ALGEBRA II       PRE-CALCULUS         CALCULUS

Academic Achievements (ex. AP or Honors Classes, Texas Scholars Program, etc) ________________

___________________________________________________________________________________

Extra-Curricular Activities: ____________________________________________________________


MEDICAL/EMERGENCY CONTACT INFORMATION:
Allergies, Physical Conditions Requiring Medication, Prescribed Medications: _____________________

____________________________________________________________________________________

Emergency Contact Information:




PLEASE RETURN COMPLETED FORM NO LATER THAN MAY 18, 2007 TO:
Sharon L. Bush, (Project GRAD Project Manager)
Associate Director
Rice University
Diversity Outreach, MS 99
P. O. Box 1892
Houston, TX 77251-1892
713-348-4351 (office)
713-348-4355 (fax)

								
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