Xavier University of Louisiana BUILD Technician Application Name: 900#: Birthday: Mailing Address: e-mail address: Phone Number: Please note that you have to be a rising graduate with a major in Biology, Chemistry, Computer Science, Math, Physics, Psychology, Public Health, or Sociology and US citizen or US permanent resident to apply. Major: Science/Math GPA (approximate): Expected graduation date: 1. From the possible projects described at http://www.xula.edu/build, which mentors are you most interested in working with? If you already have a mentor, and plan to stay with him/her, please note that instead. 2. List any BUILD activities that you have attended (discussion groups, seminars, etc.). 3. Have you taken the GRE? If yes, what were your scores and do you plan to retake it in this next year? 4. List the names of 3 college-level instructors submitting recommendations (1 must be a lab instructor or your current research supervisor): 5. Which of the following statements best describes you (this information is for the purposes of data collection)? Neither of my parents or primary caregivers attended any college or university One or both my parents or primary caregivers attended a college or university but did not graduate One or both of my parents or primary caregiver(s) is a college graduate On a separate sheet, write a personal statement including the following information: 1. 2. 3. 4. 5. Describe any obstacles you have faced (e.g. personal, educational, and financial) prior to this point in your educational career. What are your current career goals? What challenges do you see in the future as you progress down your desired career path? What do you hope to gain by participating in the program? Have you had any research experiences? If so, describe the research project(s) and your role. Submit application and transcript (will accept Banner Web transcripts) to: Ms. Amy R. Billizon BUILDProject Pathways Department of Chemistry Xavier University of Louisiana New Orleans, LA 70125 NCF Science Complex 204-G abillizo@xula.edu