Fillable Form 71245: 274-6041 2020 Summer High Ability Program (Grambling State University)

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Form 71245: 274-6041 2020 Summer High Ability Program (Grambling State University)

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A
PP
L
I
C
AT
I
O
N
FOR STUDENT
P
A
R
T
I
C
I
P
AT
I
O
N
2020 Summer High Ability Program
Gramb
ling
State
University
GSU Box 4218, Grambling, LA
71245
Telephone: (318) 274-6034 Fax: (318)
274-6041
Email: harrisja@gram.edu
1.
*
N
a
m
e
(Last)
(
F
i
r
s
t)
(
M
i
dd
l
e
)
2.
*
A
dd
r
e
ss
:
3.
*
E
m
a
il
:
(City)
(State)
(Z
i
p
)
4.
*
Phone:
( )
Cellular:
( )
5.
*
P
a
r
e
nt
/
G
u
a
r
d
i
a
n
N
a
m
e
:
6.
*
L
e
g
a
l
R
e
s
i
d
e
n
ce
(state):
7.
*
C
i
t
i
z
e
n
s
h
i
p:
yes
no
8. U.S.A.
Permanent
R
e
s
i
d
e
n
ce
(For
non
US
citizen):
yes
no
9.
*
D
a
t
e
of
Birth:
(Month)
(Day)
(
Y
ea
r)
11. How do you
d
e
s
c
r
i
b
e
y
ou
r
s
e
lf
?
10.
Gender:
M
F
B
l
a
c
k/
A
f
r
o
-
A
m
e
r
i
c
a
n
M
e
x
i
c
a
n
A
m
e
r
i
c
a
n
/
C
h
i
c
a
no
H
i
s
p
a
n
i
c
or
other
L
a
t
i
no
N
a
t
i
v
e
A
m
e
r
i
c
a
n
O
r
i
e
n
t
a
l
/
A
s
i
a
n
A
m
e
r
i
c
a
n
Other
(
s
p
e
c
i
f
y)
W
h
i
t
e
/
C
a
uc
a
s
i
a
n
Puerto
R
i
c
a
n
12.
Rank
in High
S
c
hoo
l
:
13.
L
i
s
t
a
ll
co
ll
e
g
e
s
/
un
i
v
e
r
s
i
t
i
e
s
at
w
h
i
ch
you
have taken courses.
P
l
ea
s
e
i
nc
l
ud
e
o
ff
i
c
i
a
l
s
ea
l
e
d
tr
a
n
s
c
r
i
p
t
s
from
ea
ch
co
ll
e
g
e
a
tt
e
nd
e
d.
C
o
ll
e
g
e
/U
n
i
v
e
r
s
i
t
y
City/State
Dates Attended
(MM/DD/YYYY)
From T
o
14.
Academic Advisor
N
a
m
e
:
15.
Total number
of
credit hours remaining
for
g
r
a
du
a
t
i
on:
16.
Cumulative grade point average (CGPA):
17.
Classification:
18.
Expected Graduation Date
(MM/YY):
)
one: (
)
19.
Test
I
n
f
o
r
m
a
t
i
on
(ACT or
S
AT) submit official scores to: 2020 Summer High Ability Program, GSU Box 4218, Grambling LA
71245
ACT (H
i
gh
e
s
t
S
co
r
e
s
)
Eng
li
s
h
Math
R
ea
d
i
ng
S
c
i
e
nc
e
C
o
m
po
s
i
t
e
SAT (H
i
gh
e
s
t
S
co
r
e
s
)
V
e
r
b
a
l
Math
C
o
m
po
s
i
t
e
20.
S
c
ho
l
a
s
t
i
c
Distinctions
or
hono
r
s
21.
P
l
ea
s
e
provide
two Teacher
Evaluation (Recommendation Letters).
*
N
a
m
e
of
Recommender
T
e
l
e
phon
e
/
E
m
a
il
1. T
e
l
e
phon
e
: (
E
m
a
il
:
2. T
e
l
e
ph
E
m
a
il
:
22. Submit official transcripts to: 2020 Summer High Ability Program, GSU Box 4218, Grambling LA 71245
23. P
e
r
s
on
a
l
St
a
t
e
m
e
nt
In
the
f
o
ll
o
w
i
ng
b
l
a
n
k
space
b
e
l
o
w
,
p
l
ea
s
e
i
d
e
n
t
i
f
y your
li
f
e
t
i
m
e
career
go
a
l
.
I
d
e
n
t
i
f
y your
strengths and
w
ea
k
n
e
ss
e
s
and
your
p
l
a
n
to
overcome the weakness
i
n
order
to
reach
your
li
f
e
t
i
m
e
go
a
l
.
The p
e
r
s
on
a
l
statement
h
e
l
p
s
us
i
n b
e
co
m
i
ng
a
cqu
a
i
n
t
e
d
w
i
t
h
you
as an
i
nd
i
v
i
du
a
l
i
n
ways d
i
ff
e
r
e
n
t from
courses,
grades, test scores, and other
ob
j
e
c
t
i
v
e
data.
P
l
ea
s
e
type your
p
e
r
s
on
a
l
statement and
limit to
the
space provided below
(font
s
i
z
e
Arial
11
)
.
24.
What
will
be your area
of
specialization
in
college
?
25.
*
C
E
R
T
I
F
I
C
AT
I
O
N
I
c
e
rt
i
f
y
that
a
ll
i
n
f
o
r
m
a
t
i
on
i
n
t
h
i
s
a
pp
li
c
a
t
i
on
i
s
accurate,
co
m
p
l
e
t
e
,
and
hon
e
s
t
l
y
presented.
I
understand that
a
n
y
i
n
a
ccu
r
a
t
e
or
m
i
s
l
ea
d
i
ng
i
n
f
o
r
m
a
t
i
on
or
o
m
i
ss
i
on
will
be reason
for
d
i
s
qu
a
li
f
i
c
a
t
i
on
from
f
u
rt
h
e
r
con
s
i
d
e
r
a
t
i
on
of t
h
i
s
a
pp
li
c
a
t
i
on
and
will
be cause
for r
e
s
c
i
nd
i
ng
of
the
o
ff
e
r
if
d
i
s
co
v
e
r
e
d
at a
l
a
t
e
r
d
a
t
e
.
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Date:
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Form 71245: 274-6041 2020 Summer High Ability Program (Grambling State University)

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Completed 8 February 2021

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