LEAD Application, University of Maryland, Application

LEAD Application
2009

Application Part I: Biographical Information

I am applying for the following WIE LEAD Academies: (multiple selections allowed)

	Mechanical Engineering	Saturday, May 30, 2009
	Fire Protection Engineering	Wednesday, July 8, 2009
	Civil & Environmental Engineering	Thursday, July 9, 2009
	Electrical & Computer Engineering	Monday, August 10, 2009
	Bioengineering	Tuesday, August 11, 2009
	Chemical & Biomolecular Engineering	Wednesday, August 12, 2009

Last Name:	First Name:	MI:
Home Address:
City:	State:	Zip:
Phone:	Birthdate:
Email:	Gender:

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

How did you find out about this program?

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

Have you participated in an engineering summer program before? Yes No

If yes, please provide the name, location and date you attended the program:

Program Name:

Location:

Date:

School Information

Current Grade Level:

Other:

Unweighted GPA on a 4.0 scale: Weighted GPA

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

Geometry	Algebra 2	Trigonometry/Analysis
Pre Calculus	Calculus 1	Calculus 2
Biology	Chemistry	Physics

Other Math/Science Related Courses:

Name of School:

School Address:		School City:
School State:		School Zip:

Parent/Guardian Information
Parent/Guardian Name:		Relationship to Student:
Daytime Phone:
* Email Address:		* Please provide an e-mail address that you check frequently. We will be sending you regular updates and announcements regarding your application.

Application Part II: Personal Statement

Write an essay describing why you would like to participate in the WIE LEAD Academies you've selected. This is your opportunity to present your experiences, extra-curricular activities and strengths to the selection committee. It is highly recommended that you first write your statement in a word processing file to check for spelling and grammatical errors. Then copy into notepad to remove formatting before pasting into the text box below.

( You may enter up to 1500 characters. )

characters left

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.