ASE PRELIMINARY APPLICATION

deadline: January 15, 2010

Read the following before completing the application form below!!

Thank you for applying for the 2010 ASE Program. Please follow these instructions:

You must submit your application on-line.

You must complete the preliminary application in one session.

Prepare ahead of time: Collect all necessary information before beginning to enter it (such as parent phone numbers and income status). Write your short answers to the 3 narrative questions ahead of time using Word or another program, carefully proof them, then copy and paste them into this form.

There are word limits to the short answer questions (300 words).

Your application will be sent to mentors EXACTLY as you fill it out, so be sure to present your information professionally. Proper grammar, spelling and formatting will count in your favor on this application.

Accuracy is the responsibility of the applicant! ASE staff members do not read through all application materials, nor do they use this information to pre-screen applicants.

Use one email address throughout the application period. We will provide the address that you submit here to mentors – make sure your address is professional.

Read the instructions above before completing the application form!!

Capitalization, spelling, and proper formatting will count in your favor on this application. Your answers are sent to the mentors exactly as you submit them, we will not spell check them for you or correct capitalization and formatting. Please proofread before you submit your application!

* First Name

Middle Initial

* Last Name

* Gender:

Male

Female

* Birth Date (mm/dd/yyyy)

* Current Grade:

* Mailing Address

Street Address (If different from mailing address)

* City

* State

* Zip Code

* County (not country!)

* Home Phone (format 555-555-5555)

Cell Phone (format 555-555-5555)

* Email Address (Please submit one email address to be used during the entire application process. This address will be provided to mentors.)

* Current School (full name - if you are home-schooled, please enter "Home School")

* Expected year of Graduation

* Are you a US Citizen?

Yes

No

If "no," do you have Permanent Residency status?

Yes

No

* Do you speak a language other than English at home?

No

Yes

If yes, please specify the language

ASE may have grant funds to provide a higher stiped to accepted students from household with low yearly family income (defined as students who qualify for the Federal Free and Reduced Lunch Program).

* Are you eligible for the Federal Free and Reduced Price School Lunch Program?

If you are not eligible for the Free and Reduced Lunch Program, but would like to be considered for a need-based stipend, please describe the circumstances on which you are basing your request

0/255 characters

* Please indicate any health conditions or disabilities that should be considered in the workplace. If none, put "none" in this field.

0/255 characters

* Did one or more of your parents attend college?

Parent Information

Parent/Guardian #1 Information

* First Name

* Last Name

Home Phone (if different from your own, format 555-555-5555)

* Employer

Work Phone (format 555-555-5555)

Cell Phone (format 555-555-5555)

Email Address

Home Address (if different from your own)

City

State

Zip Code

Parent/Guardian #2 Information (if not applicable, write n/a in the required fields)

* First Name

* Last Name

Home Phone (if different from your own, format 555-555-5555)

* Employer

Work Phone (format 555-555-5555)

Cell Phone (format 555-555-5555)

Email Address

Home Address (if different from your own)

City

State

Zip Code

Skills & Interests

Most ASE positions involve some work with computers. Please mark all skills in which you are proficient

List any other computer skills or programs with which you are comfortable.

0/20 words

* What is your current level of interest in pursuing education or a career in each of the following disciplines (please select 1, 2, or 3 for each discpline).

	1 (low)	2 (medium)	3 (high)
Archaeology
Biology
Biomedicine/Nursing
Chemistry
Computer Science
Earth Science (Meterology, Geology, Soil Science)
Engineering (Chemical, Civil, Electrical, Environmental, Industrial, Mechanical Transportation)
Environmental Science
Mathematics
Physics

* In college, I plan to major in (choose only one):

* Do you have a valid driver's license?

Yes

No

* Do you anticipate any difficulty with transportation to and from your internship each day?

Yes

No

Narrative Questions

* List and briefly describe particular skills you have developed, your hobbies, projects, relevant employment, volunteer experiences, etc. Include any activities that demonstrate your initiative and ability to work responsibly and creatively.

0/300 words

* Give an example of a challenging problem or project, and how you solved it or attempted to solve it.

0/300 words

* Explain your interest in the ASE Program and what you hope to gain by participating.

0/300 words

Optional Questions

Some of Saturday Academy's costs are underwritten by generous foundations, corporations and individuals. They ask that we supply statistical information about the students we serve. Your answers to the questions below are optional. Responses will be kept strictly confidential.

With what ethnic group do your primarily identify? Select only one. (If you consider yourself to be multiracial, please select additional ethnic groups in the question below)

If you consider yourself to be multiracial, with what other ethnic groups do you identify? (select all that apply)

How did you first hear about ASE?

Have you participated in other Saturday Academy programs (mark all that apply):

Classes & Workshops

LEAP

AWSEM

* Required Truthful

I certify all statements made in this application are true to the best of my knowledge

FINAL INSTRUCTIONS

Please review your answers before submitting them. These answers will be delivered to the mentors for their consideration in selecting an intern EXACTLY as you provide them.

If you wish to print a copy of the application for your records, you will have the opportunity to do so once you hit Submit. In addition, we will send an HTML version of your application to the email address you listed on this form.

Click on the SUBMIT button to submit your preliminary application.

* Indicates Response Required

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