2014Summer Science Bridge Course at the University of Utah
For Minority, Women and Refugee Students
June 15 to July31, 2015
The Deadline for the 2015Summer Bridge Course program is April 15, 2015
Application Checklist:
- This application
- Personal statement:One-page essayexpressing your interest in science and/or math, your career goals and how participation in the U of U summer Scinece Bridge Course program would help you achieve those goals.
- Two letters of recommendation written on school letterhead from math and/or science teachers.Letters of recommendation must be placed in a sealed envelope with signature on seal and mailed together with your application.
- Unofficial high school transcriptincluding one of following test scores: ACT or SAT.Please submit a copy of your unofficial transcripts. If accepted to the program, we will ask that you send official transcripts. Unofficial Transcript must be mailed together with your application and letters of recommendation.
Submission Procedure
Mail completed form and all other application material to:
Tino Nyawelo, Ph.D.
REFUGES Program Director
Department of Physics and Astronomy
James Flectcher Building 201
University of Utah
115 South 1400 East
Salt Lake City, Utah 84112
E-mail: .
Application form
Personal Information1. Name:
Last, First, Middle Initial
2. Citizenship U.S. Citizen US Resident (green card) Refugee
3. Race/Ethnic Group (optional) African American Asia Caucasian Latino Native American
Pacific Islander Other – specify
4. Gender (optional)check one Male Female Not specified
5. Date of Birth(enter as mm-dd-yyyy)
6. Permanent Address
Street
City
State Zip Code
7. Permanent Telephone(enter as xxx-xxx-xxxx)
8. Email address
9. Name (first, middle, last):
10. Relation to Applicant:
11. Permanent Telephone (enter as xxx-xxx-xxxx)
12. Email address
13. Name of High School Attended:
14. Major Field of Study:
15. Expected HS Graduation Date (mm/dd/yy):
16. Cumulative GPA:
17. Class Size:
18. Class Rank:
19. Enter your second second semeter science and math courses:
1. Course2. Course
3. Course
4. Course
5. Course
20. ACT or SAT SCORES
If you have taken the ACT or SAT more than once, list scores from the latest test:
EnglishMath
Reading
Science Reasoning
Composite
Date Taken (mm/yy)
21. Indicate any factor(s), e.g. allergy, disability, etc., that should be considered in arranging your placement in a specific laboratory setting and/or that would have an effect on your housing arrangements.
22. Personal statement: Insert your one-page essay expressing your interest in science and/or math, your career goals and how participation in the U of U summer Scinece Bridge Course program would help you achieve those goals.
RecommendationsGive the full names, mailing addresses (including high school name), phone and fax numbers, and e-mail addresses of the two references you have asked to provide recommendations.
23. Reference 1
Name:
High School
Address
Permanent Telephone (enter as xxx-xxx-xxxx):
Fax (enter as xxx-xxx-xxxx):
Email:
24. Reference 2
Name:
High School
Address
Permanent Telephone (enter as xxx-xxx-xxxx):
Fax (enter as xxx-xxx-xxxx):
Email:
25. Terms and conditions:
I certify the information provided on my scholarship application(s) is true to the best of my knowledge. I understand the transcript of credits I provide will be reviewed by scholarship committee members. I understand and give my permission for the use of the information provided in my scholarship application(s) and/or essay(s) for promotional and fundraising efforts for the College of Science in the event that I am selected as the recipient of a scholarship.
The College of Science is obligated to provide certain information to the donor(s) who fund various scholarships. Such information may include your application form, high school and/or university transcripts, and letters of recommendation. By agreeing to the these terms and conditions I hereby give the College of Science permission to provide the foregoing information to the donor(s) in the event that I am selected as the recipient of a scholarship.
Students who receive a scholarship, fellowship, or other financial aid administered by the University of Utah are required by state law to certify that they are eligible to receive the scholarship as a U.S. citizen or a citizen of another country who is lawfully present in the U.S. If students do not know whether they are in the U.S. lawfully, they should seek the advice of an immigration attorney before filing a scholarship/financial aid application.
Prior to the disbursement of any scholarship/financial aid, the University of Utah is required by law to verify the recipient’s citizenship status or lawful presence in the U.S. with the Department of Homeland Security (DHS). Once the University submits a student’s information to DHS for verification, this federal agency may have the legal right to share the information with other government agencies.
By agreeing to these terms and conditions, I certify under penalty of perjury that I am either a U.S. citizen or a citizen of another country who is lawfully present within the U.S. I understand that my lawful presence within the U.S. will be verified through the Department of Homeland Security prior to an award of this scholarship/financial aid.