Summer Academy of the Carolina Institute for the Multicultural Approach to Science (CIMAS)
Application Form for 2002

Application Procedure: It is your responsibility to be certain that we receive all the necessary materials with your application on or before the application deadline. Your application will not be considered unless all materials are included with your application.

1. Please include a Teacher Evaluation Form from a current science or mathematics teacher familiar with your academic work.

2. Applications must be submitted on or before May 1, 2002.

Application Form

Summer Academy of the Carolina Institute for the Multicultural Approach to Science Program

July 7-26, 2002

Name:
Address:	City:
State	Zip Code
Phone	Email address
Gender	Date of birth

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Ethnic Background (check all applicable):

African American

*American Indian

Asian American

Hispanic

Caucasian

*Other

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* If you chose "American Indian" above, please specify tribe. If you chose "Other" please specify.
Name of Current School	Town of Current School

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Current Grade Level:

8th

9th

Academic Background: Please list the math and science courses taken during the last two years and the grades earned in each.

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