APPLICATION FOR DEPARTMENT OF BIOLOGY HONORS PROGRAM
1. Name____________________________________ Date ____________ University ID__________________
Last
First
Middle
Circle:
Mr. Ms.
initial
2. Circle preferred address and telephone number:
a) Home address
____________________________________ Home phone _______________________
____________________________________
b) School address __________________________________
School phone ________________________
__________________________________
c) E-mail address __________________________________
Alt. email ____________________________
3. Present academic status (circle appropriate year and semester):
Year
Freshman
Sophomore Junior
Senior
st
st
st
Semester
1
1
1
1st
nd
nd
nd
2
2
2
2nd
4. Major ______________________________
Area of specialization __________________________
5. Are you or have you been a member of the University Honors Program? _________________________
6. Expected date of graduation __________________________
7. A prerequisite for participation in this program is the sponsorship of a faculty member who has agreed to
advise you in your future course work and who will direct your research project. If your mentor is off
campus, specify an on-campus co-mentor (you may need to discuss this with the Director of the Biology
Honors Program). Please provide the name, complete mailing address (including name of Department
or Institution), email address and telephone of your mentor and, if appropriate, co-mentor.
Mentor: _________________________________ Co-Mentor: ___________________________________
Department: ______________________________ Department: __________________________________
Institution: _______________________________ Institution: __________________________________
_________________________________________
___________________________________
Email address:_____________________________
Email address:________________________________
Telephone(s): _____________________________
Telephone(s): ________________________________
Signatures:
Mentor: __________________________________
Co-Mentor: _________________________________
Date:
Date: _____________________________________
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__________________________________
8. a) University of Maryland G.P.A. (grade point average) in all course work to date: __________
b) G.P.A. in biological sciences: __________
c) G.P.A. in chemical and physical sciences: __________
d) Academic Record: (include present registration)
Biology Courses
Supporting Courses (chem., physics, math, stat.,
com. sci., psych., etc.)
Course Title
Grade
Course Title
Grade
9. High School or College Academic Awards or Scholarships:
10. Were you ever associated with, or did you take an active part in any High School or college honors
curriculum or science project? Explain.
11. What are your major academic interests outside of the biological and physical sciences?
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12. What are your long term goals and career objectives?
13. Why are you submitting this application for candidacy in the Biology Honors Program?
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