The University of Southern Mississippi
2009 Summer Program for Academically Talented Youth
July 5-24,
2009
Student Application |
| Name: First:
Last:
Preferred:
|
Telephone:
-
-
Address:
City:
State:
Zip:
|
| Date of Birth:
-
-
Age:
Gender
Male
Female |
|
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Parents e-mail address:
Father's Information
Name:
Occupation:
Business Phone:
-
-
Mother's Information:
Name:
Occupation:
Business Phone:
-
-
Social Security # (no hyphens):
Student
or Mother
or
Father
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Number all courses of interest in order of preference (1 = first choice, 2 = second choice, 3 = third choice, etc., or NI = No Interest.) Only those courses with
10 or more eligible students will be conducted.
|
ACTMath……
ACTM
ACTEnglish….
ACTE
ACTScience
…ACTS
ACTReading
...ACTR |
SATMath…………….
SATM
SATCritical
Reading ..SATCR
SATWriting………….
SATW |
Number all courses of interest in order of preference (1 = first choice, 2 = second choice,
3 = third choice, etc., or NI = No Interest.) Only those courses with
10 or more eligible students will be conducted. |
| COURSES |
SCORES AFTER OCTOBER, 2004 |
|
Mathematics |
SATM> 500 or ACTM > 18 |
|
Human Anatomy and Physiology |
SATM> 500 or SATCR> 500 or ACTM> 18 or ACTE> 21 or ACTS> 22 or CTR> 21 |
|
Forensic Science |
SATM > 500 or SATCR> 500 or ACTM
> 18 or ACTE> 21 or ACTS> 22 or ACTR> 21 |
|
Polymer Science |
SATM> 500 or SATCR> 500 or ACTM> 18 or ACTE> 21 or ACTS> 22 or ACTR> 21 |
|
Economics |
SATM> 500 or SATCR> 500 or ACTM> 18 or ACTE> 21 or ACTS> 22 or ACTR> 21 |
|
Psychology |
SATM> 500 or SATCR> 500 or ACTM> 18 or ACTE> 21 or ACTS> 22 or ACTR> 21 |
|
Criminal Justice |
SATM> 500 or SATCR> 500 or ACTM> 18 or ACTE> 21 or ACTS> 22 or ACTR> 21 |
|
Creative Writing |
SATCR > 500 or SATW> 500 or ACTE> 21 or ACTR> 21 |
|
Debate |
SATCR> 500 or SATW>
500 or ACTE> 21 or ACTR
> 21 |
SAT scores:
SAT‑M
SAT‑CR
SAT‑W
Date of SAT
ACT scores:
ACT‑E
ACT‑M
ACT-R
ACT-S
Date of ACT
Grade level completed in school year 2008-2009
Grade level entering in school year 2009-2010
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School Information |
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Name and address of school in which you will be enrolled in 2009-2010
School: Name:
Address:
City:
State:
Zip
If not currently enrolled in this school please provide address of the school you are currently enrolled in:
School: Name:
Address:
City:
State:
Zip
|
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MATHEMATICS APPLICANTS ONLY: Please check the course(s) that you will have completed by the end of this school year:
Algebra I
Precalculus
Algebra II
Calculus
Geometry
Modern Analysis
Trigonometry
Check the years in which you have attended our Academically Talented Youth Program:
None
2005
2006
2007
2008
Are there any physical or emotional problems about which we should know?
Please note especially any vision or hearing problems.
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| Are you applying for Financial
Aid:
Yes
No |
If yes, we request that you first seek financial aid within your community
because of the limited funds available. |
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