California State University, Fresno METRO Program Application PERSONAL INFORMATION Name: Last First MI ID# : ______________________ Gender: Male Female Residency Status: U.S. Citizen Permanent Resident If applicable, Permanent Resident Registration Number : ______________________ Date of Birth: __________________________________ Place of Birth : _________________________________ CONTACT INFORMATION Mailing Address: ______________________________________________________________________________________________ Street Home Phone: ( ) Apt # — Cell Phone: ( ) City — State Zip Email: ___________________________ Check here if Address 2 is same as above Permanent address Street Apt # City State Zip PERSONAL BACKGROUND Ethnicity - How do you describe yourself? Please select only one: Asian Southeast Asian White Alaska Native African American/Black Hispanic/Latino Native American (Specify nation): _____ ____________ Native Hawaiian or Pacific Islander (Specify): ________________ Bicultural (Specify): _________________ Other (Specify): ________________________ What is the primary language spoken in your home? _________________________________ ACADEMIC BACKGROUND Please check what applies to you: Expected Graduation Date____________ Community College Student - I am transferring to Fresno State in 201 _____ Community College Currently Attending: _____________ Registered Number of Units: _________ GPA: ________ Fresno State Student - GPA: _______Grade Level: ______ Expected Graduation Date:_______Registered Number of Units:____ List the highest level you have taken in the following subjects and grades received Course Name (Example: Calculus, AP Biology etc.) Grade Received Geology: ____________________________________ ________ Chemistry: ____________________________________ ________ Math: ____________________________________ ________ Physics: ____________________________________ ________ Other Science: ____________________________________ ________ ACTIVITIES/HONORS List any extracurricular activities in which you have participated while attending high school or community college. List any honors/awards you have received while attending high school or community college. ACADEMIC AND CAREER GOALS Please indicate your expected or current college major. Agricultural Science Geology Biology Geomatics Engineering Chemistry Industrial Engineering Civil Engineering Mathematics Computer Science Mechanical Engineering Computer Engineering Natural Science Environmental Science Physics Other (specify): ________________________________________________ Career Objective: _________________________________________________________ (e.g. graduate study, work in industry) How did you hear about the program? METRO Poster/flyer METRO Website From a friend From an instructor From a METRO student Other (please specify): _______________________________________________ Why are you interested in the METRO Center? What do you know about the METRO Center? PERSONAL STATEMENT (PLEASE TYPE) In the space below or on a separate sheet of paper, please answer the following questions A) What interests you about Geosciences? B) Explain how your family and/or community have influenced your personal growth and your decision to pursue a college degree. C) Describe any challenges or obstacles you have had to overcome in order to pursue a science, technology, engineering or math (STEM) major. The information I have submitted in my METRO Program Application is true and accurate to the best of my knowledge. I understand that to track the progress of METRO students and to evaluate program effectiveness, the METRO Center requires access to student information. Photographs and research abstracts may also be obtained for use by the METRO program in program dissemination materials such as websites, newsletters, and reports. I am aware of the provisions of the Family Educational Rights and Privacy act and hereby authorize the release of the requested information directly to the California State University, Fresno METRO Center (i.e. transcripts, letters of recommendation, etc.). Student Signature: Print Name: Date: PLEASE MAIL YOUR APPLICATION AND TRANSCRIPTS (UNOFFICIAL ACCEPTED) TO: ATTN: Ronna Crews - METRO Administrator 2576 E. San Ramon Ave M/S ST 90 Fresno, CA. 93740-8034 OR SAVE A COPY OF YOUR COMPLETED APPLICATION AND EMAIL IT TO: rcrews@csufresno.edu For more information about METRO call (559) 278-6076 or visit us online at http://www.fresnostate.edu/csm/geosciencesmetro/