**Application Form**![](media/image1.jpeg){width="1.3895833333333334in"
height="1.0729166666666667in"}

**Summer 2009**

**Goddard Space Flight Center's**

**New York City Research Initiative (NYCRI)**

**<http://education.gsfc.nasa.gov/nycri>**

**High School Intern Program**

**A Career Experience for High School Students**

**[The Program]{.underline}**

The Goddard Space Flight Center (GSFC) High School Intern Program (HIP)
engages high school students in 'real-time' applications of science,
technology, engineering and math (STEM) in a research-focused work
world.

The Summer 2009 HIP is designed to attract and motivate outstanding
young women and men to choose a summer career experience from which to
learn more about space exploration in general, and GSFC-specific areas
of earth science, space science, engineering, and technology. Clear
expectations and mentored research lead to valued results for the
students and NASA.

This summer intern program is for a minimum of six weeks and a maximum
of eight weeks at the NASA Goddard Institute for Space Studies (GISS-
112^th^ Street at Broadway, New York, NY) or at one of the following
NYCRI academic partners: The City College of New York, Hunter College,
LaGuardia Community College, Medgar Evers College, Queensborough
Community College, New York City College of Technology, State University
of New York at Stony Brook, New Jersey Institute of Technology, Stevens
Institute of Technology, Dowling College, and Southern Connecticut State
University. Students learn and apply research protocols and processes to
a NASA research project. Some knowledge of computer applications is
essential for all placements. Participation in HIP will provide students
with an increased understanding of the relevance of high school
requirements as preparation for STEM opportunities.

Evidence of a strong aptitude in academics and demonstrated interest in
STEM are primary considerations for selection. All applicants must
submit a completed 2009 NYCRI High School Intern Program Application
Form and meet the following eligibility criteria:

-   Must be a U.S. citizen.

-   Live (maintain permanent, year-round residence) within reasonable
    commuting distance from an NYCRI academic partner or GISS.

-   Have completed the sophomore year and be 16 years of age by June 29,
    2009.

-   Be able to provide demonstration of interest in science,
    engineering, math or technology

-   Have maintained a GPA equivalent of a B or higher in science and
    math.

-   Be available to participate Monday through Friday for the duration
    of the Program.

-   Be in a position to provide daily transportation to/from GSFC.

A HIP Selection Committee will conduct the selection process to fill the
small number of available positions. To be considered in this highly
competitive process, the completed Application Form ***must be
received*** at the address listed below and postmarked no later than
**March 1, 2009*.***

**[The Application]{.underline}**

***Note: You must use the current year's NYCRI High School Intern
Program application form. Previous year's forms [will not]{.underline}
be accepted. All completed information on the Application Form should be
typed or printed legibly in black ink.***

Use the following checklist to be certain that all requested information
has been completed. Make a copy of all information for your personal
records. Submit the original Application Form to the address indicated
below.

A completed HIP application package includes forms and documentation for
the following eight (8) areas:

> \_\_\_ Student Information Form
>
> \_\_\_ Student's Education Career Information
>
> \_\_\_ Educational transcript
>
> \_\_\_ Personal Essay (Maximum of 300 words)
>
> \_\_\_ Interest and Career Preferences
>
> \_\_\_ Computer Applications/Skills Inventory
>
> \_\_\_ Parental Consent Form
>
> \_\_\_ 2 Teacher Recommendations

**Special Instructions for submission of applications.**

1.  **Materials must be sent by mail and postmarked no later than March
    1, 2009.**

2.  Applications will not be processed unless they are complete and all
    materials have been received.

3.  An incomplete application package *[will not]{.underline}* be
    forwarded to the Selection Committee.

4.  There are no provisions for accepting applications by fax or E-mail.

5.  Applicants are usually notified of their selection status by the end
    of March.

6.  Assignments are made based upon the information provided in the
    application.

7.  You will be contacted to acknowledge receipt of the application
    package.

8.  Notification of selections usually is made in April, 2009.

9.  If selected, you will receive an information packet confirming your
    internship and providing instructions for any preparatory work need
    to be completed and forms to be signed.

Questions related to the NYCRI High School Intern Program may be sent by
e-mail (please note High School Intern Program in the subject line) to:
<Frank.Scalzo-1@nasa.gov> or by phone at 212.678.6038.

Retain these instructions for your information and mail the completed
application package, including all required documentation to: **Frank
Scalzo, Ph.D.\
Education Programs Specialist\
NASA GSFC @ GISS, Room 788\
2880 Broadway at 112th Street\
New York, NY 10025**

**NYCRI <http://education.gsfc.nasa.gov/nycri>\
212-678-6038 (voice)**

**212-678-5622 (fax)\
**

**STUDENT INFORMATION FORM**

**Date Received \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date Notified of results
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**[student Information FORM]{.underline}**

***Note: All fields must be completed on this page. All information must
be typed or printed legibly using black ink.***

LAST NAME:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
First Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
M.I.:\_\_\_\_\_\_\_\_

Date of Birth: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ AGE(as
of 6/28): \_\_\_\_\_\_\_\_ GENDER: \_\_\_FEMALE \_\_\_MALE

HOME ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

STREET CITY STATE ZIP

HOME PHONE NO: (\_\_\_\_\_\_\_\_) \_\_\_\_\_\_\_\_ -
\_\_\_\_\_\_\_\_\_\_\_\_\_\_ E-MAIL ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

U.S. CITIZEN? \_\_\_\_\_\_ YES \_\_\_\_\_\_ NO SOCIAL SECURITY NUMBER:
\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_\_\_\_\_

***Note: Completion of this section is optional. It is useful for
demographic information.***

Ethnic Group (Check one that best applies)

\_\_\_\_ Black or African American \_\_\_\_ Asian (Not Pacific Islander)
\_\_\_ Native Hawaiian

\_\_\_\_ Caucasian (Not Hispanic) \_\_\_\_ Hispanic or Latino \_\_\_
American Indian or Alaska Native

\_\_\_\_ Pacific Islander \_\_\_\_ Multiracial (Please specify)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_ Other (Please specify)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Do you have a disability? \_\_\_\_\_ Yes \_\_\_\_\_No If yes, list
special needs required to complete the internship.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[Student's Education Career Information]{.underline}**

HIGH SCHOOL:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SCHOOL SYSTEM: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SCHOOL ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

STREET CITY STATE ZIP

GRADE LEVEL AS OF 2007-2008 ACADEMIC YEAR: \_\_\_\_\_\_ SOPHOMORE
\_\_\_\_\_\_ JUNIOR \_\_\_\_\_\_ SENIOR

CUMULATIVE GRADE POINT AVERAGE AS OF THE END OF THE 2008-2009 FIRST
SEMESTER ACADEMIC YEAR \_\_\_\_\_\_

NAME OF GUIDANCE OR CAREER
COUNSELOR\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TELEPHONE NUMBER
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[EDUCATIONAL TRANSCRIPT]{.underline}**

***Note: Include your current educational transcript in the application
package.***

Your transcript should include all high school courses with final grades
through the fall semester of the 2008-2009 academic year. Photocopies
are acceptable. If the transcript does not include 2008-2009 fall
semester final grades, include a copy of your current report card.

**[PERSONAL ESSAY]{.underline}**

Your personal essay is an opportunity to describe your career goals,
explain your special talents and skills, and tell why you wish to
participate in this program. Tell how you will share what you learn with
others. The essay must be typed on standard-sized paper (8 ½" x 11") and
be **signed and dated** by you, the applicant. The essay should have no
more than 300 words. Submit this essay as a part of the complete High
School Intern Program Application Package.

**[Interest and career Preferences]{.underline}**

***Note: The choices listed in this preference chart are areas highly
relevant to Goddard.***

Please rate each choice by using the numerical scale.

> **3** = Very strong interest
>
> **2** = Strong interest
>
> **1** = Some interest
>
> **0** = No desire to pursue

**[COMPUTER APPLICATIONS/SKILLS INVENTORY]{.underline}**

***Note: This information is not used as primary selection criteria, but
it is very helpful in choosing appropriate placements for selected
students.***

Use the definitions below to rate your computer applications/skill level
within the categories listed including specific software you have used.
You may add other relevant software experience in the extra spaces.

+---------+------------------------------------------------------------+
| **a     | **Definitions**                                            |
| PPLICAT |                                                            |
| IONs/** |                                                            |
|         |                                                            |
| **Skill |                                                            |
| Level** |                                                            |
+---------+------------------------------------------------------------+
| **4**   | Am very experienced with the software's basic,             |
|         | intermediate, and advanced features. Have completed many   |
|         | varied assignments and projects using the advanced         |
|         | features of this software and am able to instruct others.  |
+---------+------------------------------------------------------------+
| **3**   | have mastered all the basic and intermediate functions.    |
|         | Have completed several assignments and projects of varied  |
|         | types using the software and am able to instruct others    |
|         | about basic and intermediate software features.            |
+---------+------------------------------------------------------------+
| **2**   | Am familiar with basic features as well as some            |
|         | intermediate features. Have completed assignments using    |
|         | the software and am able to instruct beginners about       |
|         | software basics.                                           |
+---------+------------------------------------------------------------+
| **1**   | Am familiar with basic features only.                      |
+---------+------------------------------------------------------------+
| **0**   | Have not used this type of software.                       |
+---------+------------------------------------------------------------+

+-----------------------+---------+-----------------------+-----------+
| **Software**          | *       | **Software**          | **Expe    |
|                       | *Experi |                       | rience/** |
|                       | ence/** |                       |           |
|                       |         |                       | **Skill   |
|                       | **Skill |                       | Level**   |
|                       | Level** |                       |           |
+-----------------------+---------+-----------------------+-----------+
| **Operating Systems** |         | **Desktop             |           |
|                       |         | Publishing/WebPage    |           |
|                       |         | Design**              |           |
+-----------------------+---------+-----------------------+-----------+
| Windows (*Version*    |         | MS Front Page         |           |
| \_\_\_\_\_\_\_\_\_):  |         |                       |           |
+-----------------------+---------+-----------------------+-----------+
| MAC (*Version*        |         | GoLive                |           |
| \_\_\_\_\_\_\_\_\_):  |         |                       |           |
+-----------------------+---------+-----------------------+-----------+
| Linux                 |         | HTML                  |           |
+-----------------------+---------+-----------------------+-----------+
| Unix                  |         | XML                   |           |
+-----------------------+---------+-----------------------+-----------+
|                       |         | Dreamweaver           |           |
+-----------------------+---------+-----------------------+-----------+
| **Word Processing**   |         | **Computer Graphics** |           |
+-----------------------+---------+-----------------------+-----------+
| MS Word               |         | Adobe PhotoShop       |           |
+-----------------------+---------+-----------------------+-----------+
| WordPerfect           |         | Adobe Illustrator     |           |
+-----------------------+---------+-----------------------+-----------+
| Other:                |         | Corel Draw            |           |
+-----------------------+---------+-----------------------+-----------+
| **Spreadsheets**      |         | InDesign              |           |
+-----------------------+---------+-----------------------+-----------+
| MS Excel              |         |                       |           |
+-----------------------+---------+-----------------------+-----------+
|                       |         |                       |           |
+-----------------------+---------+-----------------------+-----------+
|                       |         | **Programming         |           |
|                       |         | Languages**           |           |
+-----------------------+---------+-----------------------+-----------+
| **Data Bases**        |         | C++                   |           |
+-----------------------+---------+-----------------------+-----------+
| MS Access             |         | JAVA                  |           |
+-----------------------+---------+-----------------------+-----------+
| MySQL                 |         | JAVAScript            |           |
+-----------------------+---------+-----------------------+-----------+
| FileMaker             |         | Visual Basic          |           |
+-----------------------+---------+-----------------------+-----------+
| **Internet Browsers** |         |                       |           |
+-----------------------+---------+-----------------------+-----------+
| MS Internet Explorer  |         |                       |           |
+-----------------------+---------+-----------------------+-----------+
| Netscape              |         |                       |           |
+-----------------------+---------+-----------------------+-----------+
|                       |         |                       |           |
+-----------------------+---------+-----------------------+-----------+
| **Presentation**      |         |                       |           |
+-----------------------+---------+-----------------------+-----------+
| MS PowerPoint         |         |                       |           |
+-----------------------+---------+-----------------------+-----------+

**Student, read the following statement carefully. Your signature
indicates agreement and acceptance of all provisions and the type of
internship for which you are applying.**

I hereby certify by my signature below that I understand and agree that
any misrepresentation or inaccurate information on my application form
or any other submitted materials will be cause for my disqualification
from consideration and participation in the Goddard High School Intern
Program. I also understand that if selected to participate, I must
participate for the full duration of the Program within the dates
specified. I understand that failure to do so may result in the
immediate termination of my internship.

Student's Signature
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Student's Name Printed
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[PARENTAL CONSENT FORM]{.underline}**

*Note: Parent(s) or the student's legal guardian(s) are asked to read
and sign this form.*

***Parent(s), please read the following statements carefully. Your
signature indicates your agreement with these provisions and gives your
permission for your student's participation.***

-   I hereby grant my permission for teachers (selected by my
    son/daughter) to complete the recommendation forms to be submitted
    as a part of the complete application package for the Goddard High
    School Intern Program -- Summer 2009. I understand that the
    recommendations may be used in the selection process.

-   I grant my permission for school officials to provide a current
    educational transcript and understand that the transcript may be
    used in the selection process.

-   I am aware that this is a highly competitive program with only a few
    students receiving selection. If selected, I understand that my
    son/daughter will be offered the opportunity to participate in this
    program**. If the offer is accepted, my son/daughter agrees to
    participate for the duration of the program.**

-   I understand that my son/daughter will be responsible for his/her
    own transportation to and from GISS or an NYCRI academic partner
    campus.

-   I have reviewed and concur with the information provided by my
    son/daughter in completing the application materials and will attest
    to its accuracy and truthfulness.

> Parent's
> Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Parent's Printed
Name\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Mailing
Address\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Home Phone \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Work Phone
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Teacher Recommendation Form**

***Note: Two recommendations are required using the forms provided. The
recommendations must be from the applicant's teacher of science, math,
or computer science.***

+----------------+------+---+----+------------+---+--------------------+
| **Teacher      |      |   |    |            |   |                    |
| Re             |      |   |    |            |   |                    |
| commendation - |      |   |    |            |   |                    |
| 1**            |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
| **- Science,   |      |   |    |            |   |                    |
| Mathematics,   |      |   |    |            |   |                    |
| or Computer    |      |   |    |            |   |                    |
| Science -**    |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **Teacher's    |      |   |    |            |   |                    |
| Name/Position  |      |   |    |            |   |                    |
| /Discipline:** |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **Name of      |      |   |    |            |   |                    |
| School:**      |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **How long     |      |   |    |            |   |                    |
| have you known |      |   |    |            |   |                    |
| the student?   |      |   |    |            |   |                    |
| In what        |      |   |    |            |   |                    |
| capacity?**    |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **Please rate  |      |   |    |            |   |                    |
| the student in |      |   |    |            |   |                    |
| the following  |      |   |    |            |   |                    |
| areas.**       |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **1. Ability   |      | * |    |            | * |                    |
| to follow      |      | * |    |            | * |                    |
| rules and      |      | 2 |    |            | 3 |                    |
| directions**   |      | . |    |            | . |                    |
|                |      | A |    |            | L |                    |
| -   Always     |      | c |    |            | e |                    |
|     follows    |      | c |    |            | a |                    |
|                |      | e |    |            | d |                    |
| -   Sometimes  |      | p |    |            | e |                    |
|     follows    |      | t |    |            | r |                    |
|                |      | s |    |            | s |                    |
| -   Seldom     |      | r |    |            | h |                    |
|     follows    |      | e |    |            | i |                    |
|                |      | s |    |            | p |                    |
| -   Never      |      | p |    |            | a |                    |
|     follows    |      | o |    |            | b |                    |
|                |      | n |    |            | i |                    |
|                |      | s |    |            | l |                    |
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|                |      | n |    |            | h |                    |
|                |      | s |    |            | i |                    |
|                |      | i |    |            | p |                    |
|                |      | b |    |            |   |                    |
|                |      | l |    |            | A |                    |
|                |      | e |    |            | l |                    |
|                |      |   |    |            | w |                    |
|                |      | - |    |            | a |                    |
|                |      |   |    |            | y |                    |
|                |      |   |    |            | s |                    |
|                |      |   |    |            | f |                    |
|                |      | O |    |            | o |                    |
|                |      | f |    |            | l |                    |
|                |      | t |    |            | l |                    |
|                |      | e |    |            | o |                    |
|                |      | n |    |            | w |                    |
|                |      |   |    |            | s |                    |
|                |      |   |    |            | o |                    |
|                |      |   |    |            | t |                    |
|                |      |   |    |            | h |                    |
|                |      | i |    |            | e |                    |
|                |      | r |    |            | r |                    |
|                |      | r |    |            | s |                    |
|                |      | e |    |            |   |                    |
|                |      | s |    |            |   |                    |
|                |      | p |    |            |   |                    |
|                |      | o |    |            |   |                    |
|                |      | n |    |            |   |                    |
|                |      | s |    |            |   |                    |
|                |      | i |    |            |   |                    |
|                |      | b |    |            |   |                    |
|                |      | l |    |            |   |                    |
|                |      | e |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **4.           |      | * |    |            | * |                    |
| Initiative/    |      | * |    |            | * |                    |
| Independence** |      | 5 |    |            | 6 |                    |
|                |      | . |    |            | . |                    |
| -   Seeks      |      | A |    |            | O |                    |
|     extra      |      | b |    |            | r |                    |
|     tasks      |      | i |    |            | a |                    |
|                |      | l |    |            | l |                    |
| -   Prepares   |      | i |    |            | c |                    |
|     assigned   |      | t |    |            | o |                    |
|     tasks      |      | y |    |            | m |                    |
|                |      | t |    |            | m |                    |
| -   Needs      |      | o |    |            | u |                    |
|     occasional |      | w |    |            | n |                    |
|     reminders  |      | o |    |            | i |                    |
|                |      | r |    |            | c |                    |
| -   Needs      |      | k |    |            | a |                    |
|     constant   |      | w |    |            | t |                    |
|     reminding  |      | e |    |            | i |                    |
|                |      | l |    |            | o |                    |
| ```{=html}     |      | l |    |            | n |                    |
| <!-- -->       |      | w |    |            | s |                    |
| ```            |      | i |    |            | k |                    |
| -   Seldom     |      | t |    |            | i |                    |
|     shows      |      | h |    |            | l |                    |
|     initiative |      | o |    |            | l |                    |
|                |      | t |    |            | s |                    |
|                |      | h |    |            | * |                    |
|                |      | e |    |            | * |                    |
|                |      | r |    |            |   |                    |
|                |      | s |    |            | - |                    |
|                |      | * |    |            |   |                    |
|                |      | * |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      | - |    |            | V |                    |
|                |      |   |    |            | e |                    |
|                |      |   |    |            | r |                    |
|                |      |   |    |            | y |                    |
|                |      | A |    |            |   |                    |
|                |      | l |    |            |   |                    |
|                |      | w |    |            |   |                    |
|                |      | a |    |            |   |                    |
|                |      | y |    |            | a |                    |
|                |      | s |    |            | r |                    |
|                |      |   |    |            | t |                    |
|                |      |   |    |            | i |                    |
|                |      |   |    |            | c |                    |
|                |      |   |    |            | u |                    |
|                |      | w |    |            | l |                    |
|                |      | o |    |            | a |                    |
|                |      | r |    |            | t |                    |
|                |      | k |    |            | e |                    |
|                |      | s |    |            |   |                    |
|                |      |   |    |            | - |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      | w |    |            | A |                    |
|                |      | e |    |            | r |                    |
|                |      | l |    |            | t |                    |
|                |      | l |    |            | i |                    |
|                |      |   |    |            | c |                    |
|                |      | - |    |            | u |                    |
|                |      |   |    |            | l |                    |
|                |      |   |    |            | a |                    |
|                |      |   |    |            | t |                    |
|                |      | S |    |            | e |                    |
|                |      | o |    |            |   |                    |
|                |      | m |    |            | - |                    |
|                |      | e |    |            |   |                    |
|                |      | t |    |            |   |                    |
|                |      | i |    |            |   |                    |
|                |      | m |    |            | S |                    |
|                |      | e |    |            | o |                    |
|                |      | s |    |            | m |                    |
|                |      |   |    |            | e |                    |
|                |      |   |    |            | w |                    |
|                |      |   |    |            | h |                    |
|                |      |   |    |            | a |                    |
|                |      | w |    |            | t |                    |
|                |      | o |    |            |   |                    |
|                |      | r |    |            |   |                    |
|                |      | k |    |            |   |                    |
|                |      | s |    |            |   |                    |
|                |      |   |    |            | a |                    |
|                |      |   |    |            | r |                    |
|                |      |   |    |            | t |                    |
|                |      |   |    |            | i |                    |
|                |      | w |    |            | c |                    |
|                |      | e |    |            | u |                    |
|                |      | l |    |            | l |                    |
|                |      | l |    |            | a |                    |
|                |      |   |    |            | t |                    |
|                |      | - |    |            | e |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            | - |                    |
|                |      |   |    |            |   |                    |
|                |      | S |    |            |   |                    |
|                |      | e |    |            |   |                    |
|                |      | l |    |            | D |                    |
|                |      | d |    |            | i |                    |
|                |      | o |    |            | f |                    |
|                |      | m |    |            | f |                    |
|                |      |   |    |            | i |                    |
|                |      |   |    |            | c |                    |
|                |      |   |    |            | u |                    |
|                |      |   |    |            | l |                    |
|                |      | w |    |            | t |                    |
|                |      | o |    |            | y |                    |
|                |      | r |    |            |   |                    |
|                |      | k |    |            |   |                    |
|                |      | s |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            | i |                    |
|                |      |   |    |            | n |                    |
|                |      |   |    |            |   |                    |
|                |      | w |    |            |   |                    |
|                |      | e |    |            |   |                    |
|                |      | l |    |            |   |                    |
|                |      | l |    |            | a |                    |
|                |      |   |    |            | r |                    |
|                |      | - |    |            | t |                    |
|                |      |   |    |            | i |                    |
|                |      |   |    |            | c |                    |
|                |      |   |    |            | u |                    |
|                |      | D |    |            | l |                    |
|                |      | o |    |            | a |                    |
|                |      | e |    |            | t |                    |
|                |      | s |    |            | i |                    |
|                |      |   |    |            | o |                    |
|                |      |   |    |            | n |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            | - |                    |
|                |      | n |    |            |   |                    |
|                |      | o |    |            |   |                    |
|                |      | t |    |            |   |                    |
|                |      |   |    |            | I |                    |
|                |      |   |    |            | n |                    |
|                |      |   |    |            | a |                    |
|                |      |   |    |            | r |                    |
|                |      | w |    |            | t |                    |
|                |      | o |    |            | i |                    |
|                |      | r |    |            | c |                    |
|                |      | k |    |            | u |                    |
|                |      |   |    |            | l |                    |
|                |      |   |    |            | a |                    |
|                |      |   |    |            | t |                    |
|                |      |   |    |            | e |                    |
|                |      | w |    |            |   |                    |
|                |      | e |    |            |   |                    |
|                |      | l |    |            |   |                    |
|                |      | l |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **7. Written   | **8. |   |    | **9.       |   | **10. Maturity**   |
| C              | L    |   |    | Mo         |   |                    |
| ommunication** | evel |   |    | tivation** |   | -   Always         |
|                | of   |   |    |            |   |     exhibits       |
| -   Excellent  | in   |   |    | -   Highly |   |     maturity       |
|     writing    | tere |   |    |     self   |   |                    |
|     skills     | st** |   |    | -motivated |   | -   Sometimes      |
|                |      |   |    |            |   |     exhibits       |
| -   Good       | -    |   |    | -          |   |     maturity       |
|     writing    | Exhi |   |    |  Sometimes |   |                    |
|     skills     | bits |   |    |            |   | -   Seldom         |
|                |      |   |    |  motivated |   |     exhibits       |
| -   Average    | high |   |    |            |   |     maturity       |
|     writing    |      |   |    | -   Seldom |   |                    |
|     skills     | inte |   |    |            |   | -   Immature       |
|                | rest |   |    |  motivated |   |                    |
| -   Poor       |      |   |    |            |   |                    |
|     writing    | -    |   |    | -   Lacks  |   |                    |
|     skills     |    O |   |    |            |   |                    |
|                | ften |   |    | motivation |   |                    |
|                |      |   |    |            |   |                    |
|                |   in |   |    |            |   |                    |
|                | tere |   |    |            |   |                    |
|                | sted |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                | -    |   |    |            |   |                    |
|                |   Se |   |    |            |   |                    |
|                | ldom |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |   in |   |    |            |   |                    |
|                | tere |   |    |            |   |                    |
|                | sted |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                | -    |   |    |            |   |                    |
|                |    L |   |    |            |   |                    |
|                | acks |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                | inte |   |    |            |   |                    |
|                | rest |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **Identify the |      |   |    |            |   |                    |
| strengths and  |      |   |    |            |   |                    |
| skills that    |      |   |    |            |   |                    |
| will most      |      |   |    |            |   |                    |
| promote this   |      |   |    |            |   |                    |
| student's      |      |   |    |            |   |                    |
| success in our |      |   |    |            |   |                    |
| Program:       |      |   |    |            |   |                    |
| (check all     |      |   |    |            |   |                    |
| that apply)**  |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| -   Oral       |      |   |    | -   Time   |   |                    |
|                |      |   |    |            |   |                    |
|  Communication |      |   |    | Management |   |                    |
|                |      |   |    |            |   |                    |
| -   Leadership |      |   |    | -   Int    |   |                    |
|     Skills     |      |   |    | erpersonal |   |                    |
|                |      |   |    |     Skills |   |                    |
| -   Written    |      |   |    |            |   |                    |
|                |      |   |    | -          |   |                    |
|  Communication |      |   |    |   Research |   |                    |
|                |      |   |    |            |   |                    |
| -   Career     |      |   |    |  Technique |   |                    |
|     Awareness  |      |   |    |            |   |                    |
|                |      |   |    | -          |   |                    |
|                |      |   |    |  Computer/ |   |                    |
|                |      |   |    | Technology |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **[Overall     |      | * |    |            |   |                    |
| Recommendation |      | * |    |            |   |                    |
| for the        |      | T |    |            |   |                    |
| Program]       |      | e |    |            |   |                    |
| {.underline}** |      | a |    |            |   |                    |
|                |      | c |    |            |   |                    |
| -   Very       |      | h |    |            |   |                    |
|     Highly     |      | e |    |            |   |                    |
|                |      | r |    |            |   |                    |
|    Recommended |      | C |    |            |   |                    |
|     (top 5%)   |      | o |    |            |   |                    |
|                |      | m |    |            |   |                    |
| -   Highly     |      | m |    |            |   |                    |
|                |      | e |    |            |   |                    |
|    Recommended |      | n |    |            |   |                    |
|     (top 10%)  |      | t |    |            |   |                    |
|                |      | s |    |            |   |                    |
| -              |      | * |    |            |   |                    |
|    Recommended |      | * |    |            |   |                    |
|                |      | : |    |            |   |                    |
| -              |      |   |    |            |   |                    |
|    Recommended |      |   |    |            |   |                    |
|     with       |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|   reservations |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
| -   Not        |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|    Recommended |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| Signature:     |      |   |    |            |   | Date:              |
| \_\_\_\_       |      |   |    |            |   | \_\_\_\_\_\_       |
| \_\_\_\_\_\_\_ |      |   |    |            |   | \_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_ |      |   |    |            |   | \_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| May we contact | -    |   | T  |            |   | E-mail:            |
| you for        |  Yes |   | el |            |   |                    |
| additional     |      |   | ep |            |   | \_\_               |
| information?   | -    |   | ho |            |   | \_\_\_\_\_\_\_\_\_ |
|                |   No |   | ne |            |   | \_\_\_\_\_\_\_\_\_ |
|                |      |   | N  |            |   | \_\_\_\_\_\_\_\_\_ |
|                |      |   | o. |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      |   | (\ |            |   |                    |
|                |      |   | _\ |            |   |                    |
|                |      |   | _\ |            |   |                    |
|                |      |   | _\ |            |   |                    |
|                |      |   | _\ |            |   |                    |
|                |      |   | _) |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   |  - |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| ***This form   |      |   |    |            |   |                    |
| should be      |      |   |    |            |   |                    |
| returned as    |      |   |    |            |   |                    |
| part of the    |      |   |    |            |   |                    |
| student's      |      |   |    |            |   |                    |
| application    |      |   |    |            |   |                    |
| package***     |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+

**Teacher Recommendation Form**

*Note: Two recommendations are required using the forms provided. The
recommendations must be from the applicant's teacher of science, math,
or computer science.*

+----------------+------+---+----+------------+---+--------------------+
| **Teacher      |      |   |    |            |   |                    |
| Re             |      |   |    |            |   |                    |
| commendation - |      |   |    |            |   |                    |
| 2**            |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
| **- Science,   |      |   |    |            |   |                    |
| Mathematics,   |      |   |    |            |   |                    |
| or Computer    |      |   |    |            |   |                    |
| Science -**    |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **Teacher's    |      |   |    |            |   |                    |
| Name/Position  |      |   |    |            |   |                    |
| /Discipline:** |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **Name of      |      |   |    |            |   |                    |
| School:**      |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **How long     |      |   |    |            |   |                    |
| have you known |      |   |    |            |   |                    |
| the student?   |      |   |    |            |   |                    |
| In what        |      |   |    |            |   |                    |
| capacity?**    |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **Please rate  |      |   |    |            |   |                    |
| the student in |      |   |    |            |   |                    |
| the following  |      |   |    |            |   |                    |
| areas.**       |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **1. Ability   |      | * |    |            | * |                    |
| to follow      |      | * |    |            | * |                    |
| rules and      |      | 2 |    |            | 3 |                    |
| directions**   |      | . |    |            | . |                    |
|                |      | A |    |            | L |                    |
| -   Always     |      | c |    |            | e |                    |
|     follows    |      | c |    |            | a |                    |
|                |      | e |    |            | d |                    |
| -   Sometimes  |      | p |    |            | e |                    |
|     follows    |      | t |    |            | r |                    |
|                |      | s |    |            | s |                    |
| -   Seldom     |      | r |    |            | h |                    |
|     follows    |      | e |    |            | i |                    |
|                |      | s |    |            | p |                    |
| -   Never      |      | p |    |            | a |                    |
|     follows    |      | o |    |            | b |                    |
|                |      | n |    |            | i |                    |
|                |      | s |    |            | l |                    |
|                |      | i |    |            | i |                    |
|                |      | b |    |            | t |                    |
|                |      | i |    |            | y |                    |
|                |      | l |    |            | * |                    |
|                |      | i |    |            | * |                    |
|                |      | t |    |            |   |                    |
|                |      | y |    |            | - |                    |
|                |      | * |    |            |   |                    |
|                |      | * |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      | - |    |            | S |                    |
|                |      |   |    |            | t |                    |
|                |      |   |    |            | r |                    |
|                |      |   |    |            | o |                    |
|                |      | A |    |            | n |                    |
|                |      | l |    |            | g |                    |
|                |      | w |    |            |   |                    |
|                |      | a |    |            |   |                    |
|                |      | y |    |            |   |                    |
|                |      | s |    |            |   |                    |
|                |      |   |    |            | l |                    |
|                |      |   |    |            | e |                    |
|                |      |   |    |            | a |                    |
|                |      |   |    |            | d |                    |
|                |      | a |    |            | e |                    |
|                |      | c |    |            | r |                    |
|                |      | c |    |            | s |                    |
|                |      | e |    |            | h |                    |
|                |      | p |    |            | i |                    |
|                |      | t |    |            | p |                    |
|                |      | s |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            | a |                    |
|                |      | r |    |            | b |                    |
|                |      | e |    |            | i |                    |
|                |      | s |    |            | l |                    |
|                |      | p |    |            | i |                    |
|                |      | o |    |            | t |                    |
|                |      | n |    |            | y |                    |
|                |      | s |    |            |   |                    |
|                |      | i |    |            | - |                    |
|                |      | b |    |            |   |                    |
|                |      | i |    |            |   |                    |
|                |      | l |    |            |   |                    |
|                |      | i |    |            | S |                    |
|                |      | t |    |            | o |                    |
|                |      | y |    |            | m |                    |
|                |      |   |    |            | e |                    |
|                |      | - |    |            | t |                    |
|                |      |   |    |            | i |                    |
|                |      |   |    |            | m |                    |
|                |      |   |    |            | e |                    |
|                |      | U |    |            | s |                    |
|                |      | s |    |            |   |                    |
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|                |      | a |    |            |   |                    |
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|                |      | y |    |            | x |                    |
|                |      |   |    |            | h |                    |
|                |      |   |    |            | i |                    |
|                |      |   |    |            | b |                    |
|                |      |   |    |            | i |                    |
|                |      | a |    |            | t |                    |
|                |      | c |    |            | s |                    |
|                |      | c |    |            |   |                    |
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|                |      | p |    |            |   |                    |
|                |      | t |    |            |   |                    |
|                |      | s |    |            | l |                    |
|                |      |   |    |            | e |                    |
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|                |      |   |    |            | d |                    |
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|                |      | e |    |            | s |                    |
|                |      | s |    |            | h |                    |
|                |      | p |    |            | i |                    |
|                |      | o |    |            | p |                    |
|                |      | n |    |            |   |                    |
|                |      | s |    |            | - |                    |
|                |      | i |    |            |   |                    |
|                |      | b |    |            |   |                    |
|                |      | i |    |            |   |                    |
|                |      | l |    |            | S |                    |
|                |      | i |    |            | e |                    |
|                |      | t |    |            | l |                    |
|                |      | y |    |            | d |                    |
|                |      |   |    |            | o |                    |
|                |      | - |    |            | m |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      | S |    |            |   |                    |
|                |      | o |    |            | e |                    |
|                |      | m |    |            | x |                    |
|                |      | e |    |            | h |                    |
|                |      | t |    |            | i |                    |
|                |      | i |    |            | b |                    |
|                |      | m |    |            | i |                    |
|                |      | e |    |            | t |                    |
|                |      | s |    |            | s |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      | i |    |            | l |                    |
|                |      | r |    |            | e |                    |
|                |      | r |    |            | a |                    |
|                |      | e |    |            | d |                    |
|                |      | s |    |            | e |                    |
|                |      | p |    |            | r |                    |
|                |      | o |    |            | s |                    |
|                |      | n |    |            | h |                    |
|                |      | s |    |            | i |                    |
|                |      | i |    |            | p |                    |
|                |      | b |    |            |   |                    |
|                |      | l |    |            | A |                    |
|                |      | e |    |            | l |                    |
|                |      |   |    |            | w |                    |
|                |      | - |    |            | a |                    |
|                |      |   |    |            | y |                    |
|                |      |   |    |            | s |                    |
|                |      |   |    |            | f |                    |
|                |      | O |    |            | o |                    |
|                |      | f |    |            | l |                    |
|                |      | t |    |            | l |                    |
|                |      | e |    |            | o |                    |
|                |      | n |    |            | w |                    |
|                |      |   |    |            | s |                    |
|                |      |   |    |            | o |                    |
|                |      |   |    |            | t |                    |
|                |      |   |    |            | h |                    |
|                |      | i |    |            | e |                    |
|                |      | r |    |            | r |                    |
|                |      | r |    |            | s |                    |
|                |      | e |    |            |   |                    |
|                |      | s |    |            |   |                    |
|                |      | p |    |            |   |                    |
|                |      | o |    |            |   |                    |
|                |      | n |    |            |   |                    |
|                |      | s |    |            |   |                    |
|                |      | i |    |            |   |                    |
|                |      | b |    |            |   |                    |
|                |      | l |    |            |   |                    |
|                |      | e |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **4.           |      | * |    |            | * |                    |
| Initiative/    |      | * |    |            | * |                    |
| Independence** |      | 5 |    |            | 6 |                    |
|                |      | . |    |            | . |                    |
| -   Seeks      |      | A |    |            | O |                    |
|     extra      |      | b |    |            | r |                    |
|     tasks      |      | i |    |            | a |                    |
|                |      | l |    |            | l |                    |
| -   Prepares   |      | i |    |            | c |                    |
|     assigned   |      | t |    |            | o |                    |
|     tasks      |      | y |    |            | m |                    |
|                |      | t |    |            | m |                    |
| -   Needs      |      | o |    |            | u |                    |
|     occasional |      | w |    |            | n |                    |
|     reminders  |      | o |    |            | i |                    |
|                |      | r |    |            | c |                    |
| -   Needs      |      | k |    |            | a |                    |
|     constant   |      | w |    |            | t |                    |
|     reminding  |      | e |    |            | i |                    |
|                |      | l |    |            | o |                    |
| ```{=html}     |      | l |    |            | n |                    |
| <!-- -->       |      | w |    |            | s |                    |
| ```            |      | i |    |            | k |                    |
| -   Seldom     |      | t |    |            | i |                    |
|     shows      |      | h |    |            | l |                    |
|     initiative |      | o |    |            | l |                    |
|                |      | t |    |            | s |                    |
|                |      | h |    |            | * |                    |
|                |      | e |    |            | * |                    |
|                |      | r |    |            |   |                    |
|                |      | s |    |            | - |                    |
|                |      | * |    |            |   |                    |
|                |      | * |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      | - |    |            | V |                    |
|                |      |   |    |            | e |                    |
|                |      |   |    |            | r |                    |
|                |      |   |    |            | y |                    |
|                |      | A |    |            |   |                    |
|                |      | l |    |            |   |                    |
|                |      | w |    |            |   |                    |
|                |      | a |    |            |   |                    |
|                |      | y |    |            | a |                    |
|                |      | s |    |            | r |                    |
|                |      |   |    |            | t |                    |
|                |      |   |    |            | i |                    |
|                |      |   |    |            | c |                    |
|                |      |   |    |            | u |                    |
|                |      | w |    |            | l |                    |
|                |      | o |    |            | a |                    |
|                |      | r |    |            | t |                    |
|                |      | k |    |            | e |                    |
|                |      | s |    |            |   |                    |
|                |      |   |    |            | - |                    |
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|                |      |   |    |            | a |                    |
|                |      |   |    |            | t |                    |
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|                |      | o |    |            |   |                    |
|                |      | m |    |            | - |                    |
|                |      | e |    |            |   |                    |
|                |      | t |    |            |   |                    |
|                |      | i |    |            |   |                    |
|                |      | m |    |            | S |                    |
|                |      | e |    |            | o |                    |
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|                |      |   |    |            | e |                    |
|                |      |   |    |            | w |                    |
|                |      |   |    |            | h |                    |
|                |      |   |    |            | a |                    |
|                |      | w |    |            | t |                    |
|                |      | o |    |            |   |                    |
|                |      | r |    |            |   |                    |
|                |      | k |    |            |   |                    |
|                |      | s |    |            |   |                    |
|                |      |   |    |            | a |                    |
|                |      |   |    |            | r |                    |
|                |      |   |    |            | t |                    |
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|                |      |   |    |            | t |                    |
|                |      | - |    |            | e |                    |
|                |      |   |    |            |   |                    |
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|                |      |   |    |            |   |                    |
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|                |      | l |    |            | D |                    |
|                |      | d |    |            | i |                    |
|                |      | o |    |            | f |                    |
|                |      | m |    |            | f |                    |
|                |      |   |    |            | i |                    |
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|                |      | w |    |            | t |                    |
|                |      | o |    |            | y |                    |
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|                |      |   |    |            | n |                    |
|                |      |   |    |            |   |                    |
|                |      | w |    |            |   |                    |
|                |      | e |    |            |   |                    |
|                |      | l |    |            |   |                    |
|                |      | l |    |            | a |                    |
|                |      |   |    |            | r |                    |
|                |      | - |    |            | t |                    |
|                |      |   |    |            | i |                    |
|                |      |   |    |            | c |                    |
|                |      |   |    |            | u |                    |
|                |      | D |    |            | l |                    |
|                |      | o |    |            | a |                    |
|                |      | e |    |            | t |                    |
|                |      | s |    |            | i |                    |
|                |      |   |    |            | o |                    |
|                |      |   |    |            | n |                    |
|                |      |   |    |            |   |                    |
|                |      |   |    |            | - |                    |
|                |      | n |    |            |   |                    |
|                |      | o |    |            |   |                    |
|                |      | t |    |            |   |                    |
|                |      |   |    |            | I |                    |
|                |      |   |    |            | n |                    |
|                |      |   |    |            | a |                    |
|                |      |   |    |            | r |                    |
|                |      | w |    |            | t |                    |
|                |      | o |    |            | i |                    |
|                |      | r |    |            | c |                    |
|                |      | k |    |            | u |                    |
|                |      |   |    |            | l |                    |
|                |      |   |    |            | a |                    |
|                |      |   |    |            | t |                    |
|                |      |   |    |            | e |                    |
|                |      | w |    |            |   |                    |
|                |      | e |    |            |   |                    |
|                |      | l |    |            |   |                    |
|                |      | l |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **7. Written   | **8. |   |    | **9.       |   | **10. Maturity**   |
| C              | L    |   |    | Mo         |   |                    |
| ommunication** | evel |   |    | tivation** |   | -   Always         |
|                | of   |   |    |            |   |     exhibits       |
| -   Excellent  | in   |   |    | -   Highly |   |     maturity       |
|     writing    | tere |   |    |     self   |   |                    |
|     skills     | st** |   |    | -motivated |   | -   Sometimes      |
|                |      |   |    |            |   |     exhibits       |
| -   Good       | -    |   |    | -          |   |     maturity       |
|     writing    | Exhi |   |    |  Sometimes |   |                    |
|     skills     | bits |   |    |            |   | -   Seldom         |
|                |      |   |    |  motivated |   |     exhibits       |
| -   Average    | high |   |    |            |   |     maturity       |
|     writing    |      |   |    | -   Seldom |   |                    |
|     skills     | inte |   |    |            |   | -   Immature       |
|                | rest |   |    |  motivated |   |                    |
| -   Poor       |      |   |    |            |   |                    |
|     writing    | -    |   |    | -   Lacks  |   |                    |
|     skills     |    O |   |    |            |   |                    |
|                | ften |   |    | motivation |   |                    |
|                |      |   |    |            |   |                    |
|                |   in |   |    |            |   |                    |
|                | tere |   |    |            |   |                    |
|                | sted |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                | -    |   |    |            |   |                    |
|                |   Se |   |    |            |   |                    |
|                | ldom |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                |   in |   |    |            |   |                    |
|                | tere |   |    |            |   |                    |
|                | sted |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                | -    |   |    |            |   |                    |
|                |    L |   |    |            |   |                    |
|                | acks |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|                | inte |   |    |            |   |                    |
|                | rest |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **Identify the |      |   |    |            |   |                    |
| strengths and  |      |   |    |            |   |                    |
| skills that    |      |   |    |            |   |                    |
| will most      |      |   |    |            |   |                    |
| promote this   |      |   |    |            |   |                    |
| student's      |      |   |    |            |   |                    |
| success in our |      |   |    |            |   |                    |
| Program:       |      |   |    |            |   |                    |
| (check all     |      |   |    |            |   |                    |
| that apply)**  |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| -   Oral       |      |   |    | -   Time   |   |                    |
|                |      |   |    |            |   |                    |
|  Communication |      |   |    | Management |   |                    |
|                |      |   |    |            |   |                    |
| -   Leadership |      |   |    | -   Int    |   |                    |
|     Skills     |      |   |    | erpersonal |   |                    |
|                |      |   |    |     Skills |   |                    |
| -   Written    |      |   |    |            |   |                    |
|                |      |   |    | -          |   |                    |
|  Communication |      |   |    |   Research |   |                    |
|                |      |   |    |            |   |                    |
| -   Career     |      |   |    |  Technique |   |                    |
|     Awareness  |      |   |    |            |   |                    |
|                |      |   |    | -          |   |                    |
|                |      |   |    |  Computer/ |   |                    |
|                |      |   |    | Technology |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| **[Overall     |      | * |    |            |   |                    |
| Recommendation |      | * |    |            |   |                    |
| for the        |      | T |    |            |   |                    |
| Program]       |      | e |    |            |   |                    |
| {.underline}** |      | a |    |            |   |                    |
|                |      | c |    |            |   |                    |
| -   Very       |      | h |    |            |   |                    |
|     Highly     |      | e |    |            |   |                    |
|                |      | r |    |            |   |                    |
|    Recommended |      | C |    |            |   |                    |
|     (top 5%)   |      | o |    |            |   |                    |
|                |      | m |    |            |   |                    |
| -   Highly     |      | m |    |            |   |                    |
|                |      | e |    |            |   |                    |
|    Recommended |      | n |    |            |   |                    |
|     (top 10%)  |      | t |    |            |   |                    |
|                |      | s |    |            |   |                    |
| -              |      | * |    |            |   |                    |
|    Recommended |      | * |    |            |   |                    |
|                |      | : |    |            |   |                    |
| -              |      |   |    |            |   |                    |
|    Recommended |      |   |    |            |   |                    |
|     with       |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|   reservations |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
| -   Not        |      |   |    |            |   |                    |
|                |      |   |    |            |   |                    |
|    Recommended |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| Signature:     |      |   |    |            |   | Date:              |
| \_\_\_\_       |      |   |    |            |   | \_\_\_\_\_\_       |
| \_\_\_\_\_\_\_ |      |   |    |            |   | \_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_ |      |   |    |            |   | \_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
| \_\_\_\_\_\_\_ |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| May we contact | -    |   | T  |            |   | E-mail:            |
| you for        |  Yes |   | el |            |   |                    |
| additional     |      |   | ep |            |   | \_\                |
| information?   | -    |   | ho |            |   | _\_\_\_\_\_\_\_\_\ |
|                |   No |   | ne |            |   | _\_\_\_\_\_\_\_\_\ |
|                |      |   | N  |            |   | _\_\_\_\_\_\_\_\_l |
|                |      |   | o. |            |   |                    |
|                |      |   |    |            |   |                    |
|                |      |   | (\ |            |   |                    |
|                |      |   | _\ |            |   |                    |
|                |      |   | _\ |            |   |                    |
|                |      |   | _\ |            |   |                    |
|                |      |   | _\ |            |   |                    |
|                |      |   | _\ |            |   |                    |
|                |      |   | _) |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   |  - |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
|                |      |   | \_ |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+
| ***This form   |      |   |    |            |   |                    |
| should be      |      |   |    |            |   |                    |
| returned as    |      |   |    |            |   |                    |
| part of the    |      |   |    |            |   |                    |
| student's      |      |   |    |            |   |                    |
| application    |      |   |    |            |   |                    |
| package***     |      |   |    |            |   |                    |
+----------------+------+---+----+------------+---+--------------------+