RACIAL BACKGROUND (please check all that apply): American Indian/Alaska Native, Tribal Affiliation: __________________________________________________________ African American or Black Hmong Latino/a Other: Cambodian Native Hawaiian or Pacific Islander ____________________________ Caucasian or Laotian Vietnamese CUMULATIVE WEIGHTED HIGH SCHOOL GPA: ____________________ UNWEIGHTED GPA: ____________________ SCIENCE/MATH COURSES TAKEN OR WILL TAKE (please check all that apply): COURSE NAME TAKEN PLANNED ADVANCED INTERNATIONAL PLACEMENT (AP)? BACCALAUREATE (IB)? (Grade received?) (When?) Anatomy/Physiology Biology Chemistry Physical Science Physics Zoology Analysis/Pre-calculus Calculus Statistics Please check here if your high school does not offer AP or IB course work. HIGH SCHOOL AWARDS/HONORS: AWARD/HONOR BRIEF DESCRIPTION DATE AWARDED HIGH SCHOOL LEADERSHIP ROLES: LEADERSHIP ROLE BRIEF DESCRIPTION OF DATES OF INVOLVEMENT APPROXIMATE RESPONSIBILITIES MONTH/YEAR) –
RACIAL BACKGROUND (please check all that apply): American Indian/Alaska Native, Tribal Affiliation: __________________________________________________________ African American or Black Hmong Latino/a Other: Cambodian Native Hawaiian or Pacific Islander ____________________________ Caucasian or Laotian Vietnamese CUMULATIVE WEIGHTED HIGH SCHOOL GPA: ____________________ UNWEIGHTED GPA: ____________________ SCIENCE/MATH COURSES TAKEN OR WILL TAKE (please check all that apply): COURSE NAME TAKEN (Grade received?) PLANNED (When?) ADVANCED PLACEMENT (AP)? INTERNATIONAL BACCALAUREATE (IB)? Anatomy/Physiology Biology Chemistry Physical Science Physics Zoology Analysis/Pre-calculus Calculus Statistics Please check here if your high school does not offer AP or IB course work. HIGH SCHOOL AWARDS/HONORS: AWARD/HONOR BRIEF DESCRIPTION DATE AWARDED HIGH SCHOOL LEADERSHIP ROLES: LEADERSHIP ROLE BRIEF DESCRIPTION OF RESPONSIBILITIES DATES OF INVOLVEMENT – MONTH/YEAR) APPROXIMATE
2017-PSP_Application.docx