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2011 Science FIRST Application

2011 Science FIRST Program (Class of 2012)
July 11-14 & 18-21, 2011 - (9am-4pm)

Review of Application will begin April 1, 2011 and will continue until openings are filled or June 17, whichever comes first.

How did you hear about the program?:

Full Name:




Zip Code:

Applicant's Cell Phone (optional):


Home Phone:

Parent's Cell/Alternate Phone (optional):

Parent's Email (optional):

High School Name:

High School Address (optional):

High School City:

High School State (optional):

High School Zip Code (optional):

High School Phone (optional):

High School Graduation Date:

Ethnicity (optional):
African American/Black
Alaskan Native
Asian American
Hispanic American/Latino
Native American

Gender (optional):

Please check if you have qualified or participated in any of these programs: reduced/free lunch program, test fee waiver from ACT/SAT, admissions application fee waiver or other public assistance programs.

What is your anticipated major in college? (optional)

High School Achievements: 3.0 or above GPA and/or 'C' minimum grade in Science, Math and English
Subject Year Taken Name of Course Grade Received
Science 9th Grade
Science 10th Grade
Science 11th Grade
Math 9th Grade
Math 10th Grade
Math 11th Grade
English 9th Grade
English 10th Grade
English 11th Grade

Cumulative GPA at time of application:

Have you taken Honors/AP or college level courses? (if yes, please enter):

Science and math courses planned for next year:

Honors, Awards and Extra Curricular Activities:

In 250 words, or less, please respond to the following question: What do you hope to accomplish by participating in Ursuline College Science FIRST?

I certify that the information listed on this application is complete, accurate and true:

back to Science FIRST page.