DIRECT-STEM Application
I. General Information
Name:
Sex:
Last
First
Middle
Street
City
Zip Code
Male
Address:
Telephone: (
)
Female
Email:
Please include area code
Please provide an email, this is our main form of communication.
Place of Birth:
Citizenship:
US. Citizen
Permanent Resident
City, State, & Country
Date of Birth: ________________________(MM/DD/YY)
Ethnic Identity (for statistical purposes only)
African American
Chicano(a)/Mexican American
Other Hispanic/Latino(a)
Asian American
Filipino
American Indian
Pacific Islander
White/Caucasian
Other (specify):
1. II. Personal Information
A. What is the primary language spoken in your home?
B. Please indicate your parents’ level of education:
Mother:
Father:
No College
No College
Some College
Some College
College Graduate
College Graduate
Some Graduate School
Some Graduate School
Completed Graduate School
Completed Graduate School
C. What special needs to you have?
D. Are you registered with the office for students with special needs?
Yes
No
E. As an undergraduate, are/were you eligible for need-based financial aid?
Yes
No
F. Are you treated as an independent student for financial aid purposes?
Yes
No
G. What is your personal yearly income?
Less than $12,000
$12,001 - $21,000
$21,001 - $35,000
More than $35,000
$40,001 - $45,000
More than $45,000
H. What is your family’s yearly income?
Less than $30,000
$30,001 - $40,000
I. How many hours per week do you work during school?
J.
0 – 20
21+
Did your spouse or family provide major help with the cost of your undergraduate education?
Yes
No
III. Educational Information
Name of campus you are now attending:
Your class level in spring 2016:
Freshman
Major:
Sophomore
Junior
Senior
Graduate
Minor (if any):
Date you expect to receive your degree:
G.P.A (Grade Point Average, 4.0 = A):
Undergraduate GPA
GPA in Major
If you have taken GRE,
Please provide your GRE scores (if you have:
Verbal
Math
Analytical
Subject
For Junior, Senior, and Graduate students only:
Which department do you wish to work for research project:
Computer Science
Geosciences and Environment
Civil Engineering
Physics and Astronomy