STUDENT APPLICATION
2019 Engineering Summer Math and Projects Bootcamp
1. Student Information
Legal First and Last Name: __________________________ Major: ______________________________
Student ID__________________________
Home telephone number: ________________________Student cell number: _______________________
Email address: ________________________________________ Gender: _________________________
Mailing address: _______________________________________________________________________
City / State: ____________________________________________ Zip: __________________________
Ethnic Background: (Mark all that apply)
___ Asian ___ American Indian/Alaskan Native ___ African American/Black
___ Hispanic/Latino(a) ___ Native Hawaiian or Pacific Islander
___ White (Non-Hispanic/Latino(a)) ___ Two or more / Other (please state) ________________
2. Family Information
Mother’s name: _________________________
Occupation: ____________________________
Phone number: __________________________
Father’s name: ___________________________
Occupation: _____________________________
Phone number: ___________________________
Guardian name: _________________________
Occupation: ____________________________
Phone number: __________________________
3. Education
a. Please list all schools you have attended in the last five years. List the school you are presently
attending first.
___________________________________________________________________________________
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