Kent State NOYCE Internship Program
Application for Admission for Summer 2013
Application Directions: Use this Application form to apply to the KSU Robert Noyce
Internship Program if :
o You are a freshman or sophomore math or science major
o Your academic performance is an overall GPA of 2.75 and 3.00 in the major
o You are a U. S. citizen or permanent resident
Along with this form, you will need to submit

A Resume

A brief (2 page, single-spaced maximum) essay highlighting your
interest in science/math and experiences working with youth

Two letters of recommendation (preferably one from an individual
familiar with the applicant’s work with youth and one from a college
science/math faculty member).
o
You will be asked to appear for a brief interview as part of the selection process.
Please complete the application form along with your resume, essay and two letters of
recommendation, and send to: Dr. Lisa Borgerding (Donnelly)
The Kent State University NOYCE Internship Program
College of Education, Health, and Human Services
Room 404 White Hall
Kent State University
Kent, Ohio 44242
Application deadline – May 3, 2013
Section 1: Applicant Information (please print or type)
Name: Last __________________________ First ______________________ MI __________
Address: _____________________________________________________________________
City State Zip Code __________________________________________________
Phone(s):_________
E-Mail Address: _______________________________________________________________
Date of Birth: _____________ Gender: M F
I am a:
□ US Citizen
□ Permanent Resident
Section 2: Please indicate which of the following categories you identify with. You may check more than
one.
□ Alaskan Native (Eskimo or Aleut)
□ Hispanic or Latino
□ American Indian □ Native Pacific Islander
□ Asian
□ White
□ Black or African American
□ Other ______________
□ Decline to State
Section 3: List all colleges and the dates attended.
Section 4: Number of Credits Completed: _____________ GPA: _____
Date degree expected or attained: _______________
Major (e.g., mathematics, chemistry, etc): ________________
Section 5: Recommendations
Name of Recommender One: ___________________________________
Name of Recommender Two: ___________________________________
The information that I have provided in this application is correct to the best of my knowledge.
_________________________________________
Applicant’s Signature Date
Kent State University does not discriminate on the basis of race, religion, sex, age, creed, color, national origin, physical or mental
disability, sexual orientation, marital status, citizenship status, or veteran status. Please be aware that all documents submitted in
support of an application for admission become the permanent possession of Kent State University and will not be returned.
Please be certain that all of the information requested in the application is answered fully and correctly.