UPWARD BOUND MATH/SCIENCE REGIONAL INSTITUTE
(Part 1 of 2)
Date of Birth:
Social Security Number:
American Indian/Alaskan Native
Asian/ Pacific Islander
Current Grade Level:
Do you have a disability (physical,emotional, learning)?
If So, describe:
Math Classes Completed:
Math Courses Planned for Next Year:
Science Classes Completed:
Science Courses Planned for Next Year:
Is Either Parent/Guardian a graduate of a 4-year college or university?
If Yes, name of school:
Number of persons living in the household:
With Whom Do You Live With:
What clubs, hobbies, or extra-curricular activities do you participate in?
What are your favorite and least favorite courses at school and why?
In your opinion, what is the most significant mathematical or scientific development that affects our everyday lives? Defend your perspective
Why do you want to participate in the Math/Science institute? What do you expect to require by your participation and what will you contribute?
Have you made any commitments that would prevent uninterrupted, complete participation for the time period June 17, 2005 through July 23, 2005?
Do you need transportation to Morehouse College?