Application for the
University Bound Summer Program
Sponsored by Center for Advanced Automotive Technology (CAAT)
PLEASE PRINT
First Name
Middle Initial
Last Name
Address
City
State
Zip Code
E-Mail Address
Telephone Number
Student ID Number
Major
Campus attended at MCC:
 Center Campus  South Campus  East Campus  M-TEC
Date of Birth
Gender (Circle)
/
/
Male or Female
Are you employed?
Employer’s Company Name
Number of Hours working per week
Are you receiving Financial Aid? (Circle)
Yes or No
Total Credit Hours registered for this semester:
Semester (Circle): Fall or Winter or Spr/Sum
What is your current career goal?
What year did you graduate or will be graduating from high school?
High School GPA
How would you rate your previous academic experience? ( Circle)
Excellent
Good
Fair
Poor
What concerns, if any, do you have about attending college?
What subjects, if any, do you find difficult?
Emergency Contact:
Telephone Number:
PLEASE READ AND INITIAL:
In compliance with the Family Educational Right and Privacy Act of 1974, I permit the University Bound/CAAT
program to review my college and university credentials, including my transcript(s).
Initials:
Student Signature
Date
UB/CAAT Reviewer
Date
FAX or EMAIL completed application to: Joyce Lien – 313.577.1781; joycelien@wayne.edu
***OFFICE USE ONLY***