Savannah State University Bridge Program
Summer 2013 Application
1. BEFORE YOU BEGIN
This is a 6 part Application with essay and reference sections. You will need to gather the
following information to complete this application:
 Your permanent resident visa (if you are not a U.S. Citizen).
 A list of currently attending and previously attended colleges, universities, and high schools.
 A list of non-academic activities that you are currently participating in or have participated in.
 A list of honors/rewards you have received and/or a list of honorary organizations to which you
belong.
 A list of employers or scholarship/fellowship awards with dates.
 Contact information (including email address) for 2 references. Academic references are
preferred.
 A 500 word MAXIMUM essay describing your educational/academic career interests and
goals and how you will benefit from participation in this program. Include college science,
technology, engineering or mathematics courses that you have completed or in which you are
enrolled. Also include in the essay any disabilities or economic/educational obstacles that you
may have overcome or are working to overcome.
For your application to be considered complete, a copy of your unofficial college transcripts will also
need to be emailed to ssubridgetoresearch@savannahstate.edu no later than March 11.
For more information about the Savannah State University Bridge to Research for Undergraduates
Program please visit: http://www.savannahstate.edu/marinesciences, then click on "Internships and
fellowships."
For questions about the program contact:
Dr. Tara Cox, Assistant Professor
Marine Sciences
Savannah State University
Box 20467, Savannah, Georgia 31404
Phone: 912-358-4097
ssubridgetoresearch@savannahstate.edu
Savannah State University Bridge Program
Summer 2013 Application
2. STUDENT INFORMATION
First
Name
Middle
Last Name
Your social security number will be required to process payments and/or reimbursements for the
program. If you are unwilling to share your social security number at this time, we can obtain it over
the phone.
Social Security No.
Date of Birth
Permanent Home
Address
City
State
Zip
Email
Home Phone
Cell Phone
Emergency
Contact Name
Relationship to
Applicant
Address
State
City
Zip
Phone
Email
Current College
or University
Address
Country
(if not USA)
Current
Major
Freshmen
Current
GPA
Sophomore
Other (specify)
Are you a first generation college student?
Yes
No
(This information is for tracking purposes only and will have no bearing on the success of your
application.)
Are you a U.S. Citizen or Permanent Resident?
If you are a permanent resident
please list your visa type.
Yes
No
Savannah State University Bridge Program
Summer 2013 Application
Are you a:
Male
Female
Select your
Ethnicity
(select
only one)
African
American
Mexican
American/Chicano
American
Indian/Alaskan Native
White/
Caucasian
Puerto
Rican/Mainland
Puerto
Rican/Commonwealth
Native Hawaiian
Asian
Other Pacific Islander
Other (specify)
3. EDUCATION & AWARDS
For EDUCATION questions, list your most recent high school and college first.
Name of
High School
Location
Graduation Date
(MM/YYYY)
Name of
High School
Location
Graduation Date
(MM/YYYY)
Name of
High School
Location
Graduation Date
(MM/YYYY)
Savannah State University Bridge Program
Summer 2013 Application
College Name
Location
Graduation Date
(MM/YYYY)
College Name
Location
Graduation Date
(MM/YYYY)
College Name
Location
Graduation Date
(MM/YYYY)
Please list any school or community non-academic activities:
List any honors you have received, honorary organizations to which you belong,
and offices held.
Savannah State University Bridge Program
Summer 2013 Application
Are you now employed or do you hold a
scholarship or fellowship award?
Yes
No
If you answered "Yes" in the previous question, please list employers and awards below.
Position/Award
Employer/Source of Award
Dates (MM/YYYY – MM/YYYY)
Position/Award
Employer/Source of Award
Dates (MM/YYYY – MM/YYYY)
Position/Award
Employer/Source of Award
Dates (MM/YYYY – MM/YYYY)
Savannah State University Bridge Program
Summer 2013 Application
4. Essay
Please describe your educational/academic career interests and goals and how you will benefit
from participation in this program. Include college science, technology, engineering or
mathematics courses that you have completed or in which you are enrolled. Also describe any
disabilities or economic/educational obstacles that you may have overcome or are working to
overcome. Limit your essay to 500 words MAXIMUM.
Savannah State University Bridge Program
Summer 2013 Application
5. Transcripts
Please submit an unofficial copy of your college transcripts along with your application via email to:
ssubridgetoresearch@savannahstate.edu
If transcripts are sent separately, they must be received no later than March 11.
Make sure to include the following information in the email body:



Your Full Name
Contact Information
Year for Which You are Applying
6. References & Signature
Two (2) references are required for consideration. Academic references are preferred.
(Please provide your references contact info only. We will contact your references directly for
recommendations)
Reference Name 1
School/Affiliation
Title
Phone
Email
Reference Name 2
School/Affiliation
Title
Phone
Email
I swear that all information in this application is true and understand that I may be subject to
termination and/or criminal prosecution for false statements contained in my application packet.
Please Type your
Full Legal Name
Date