Exploring Engineering at University of Maryland, Application

Exploring Engineering at the University of Maryland
E²@UMD 2008

E²@UMD Application Part I: Biographical Information

Last Name:		First Name:	MI:
Address:
City:		State:	Zip:
Phone:		Birthday:
*Email:	>>	* Please give us an e-mail address that you check frequently. We will be sending you regular updates and announcements regarding your application.

Current Grade Level:

GPA: (Grade Point Average)

Race/Ethnicity: (for statistical purposes only) Please check all that apply

	Asian American/Pacific Islander/Asian		Latino/a
	African American/Black		Multiracial/Multiethnic
	Caucasian/White		Other (Please specify)
	American Indian/Alaskan Native

During the Program, we have the opportunity to take tours at a variety of companies and facilities. Some of these tours require participants to be either US Citizens or Permanent Residents. For planning purposes only, please check the box if you are able to participate in tours that require US citizenship/permanent residency. We will only visit these particular companies if all of our participants are able to attend.

Parent/Guardian name:		Relationship to Student:
Business Phone:		Email Address:

Name of School:

School Address:		School City:
School State:		School Zip:
School Phone:		School Fax:

Please indicate which courses you have completed or are currently taking:

Geometry	Algebra II	Intro to Engineering
Pre-Calculus	Calculus I	Calculus II
Biology	Chemistry	Physics

Other math/science related courses:

What science and math courses do you plan to take next year?

Which week do you prefer to attend?

How did you find out about this program?

	High School Counselor		Science/Math Teacher
	Internet		Summer Program Fair
	Past Participant		Other (please specify):

Have you participated in an engineering summer program before?

If yes, please provide the name, location and date you attended the program. (For multiple programs, please list only the most recently attended)
Program Name:	Location:	Date:

By checking this box, I confirm that the information included is accurate to the best of my
knowledge and that my parent/legal guardian is aware that I am applying for this program.

Note: Please be assured that your information is secure. When you click submit, you may get a security warning popup. This is because you are being redirected to the "Thank You" page that is not on the secure server. Just click "OK" or "Continue Anyway" to continue.