California State University, Fresno
METRO Summer Research Program 2013 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
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)
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 Application is true and accurate to the best of my knowledge. I understand that to
track the progress of 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 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
Application deadline: April 26, 2013
For more information about METRO call (559) 278-6076 or visit us online at http://www.fresnostate.edu/csm/geosciencesmetro/