Project SEED - North Carolina
Application Form for 2006

**NOTE: This application form is for North Carolina residents only.**

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 send a copy of your most recent official high school transcript; the transcript should include PSAT, SAT, or ACT test scores. Send it to:

    Project SEED
    CIIT-Centers for Health Research
    PO Box 12137
    Research Triangle Park, NC 27709-2137

  2. Also, include a Teacher Evaluation Form from a current science teacher (preferably chemistry) familiar with your academic work.

  3. You must submit this form electronically.

  4. You must write an essay (250 words minimum).

  5. Applications, transcripts, and recommendations must be postmarked on or before May 15, 2006.
go to the online Teacher Evaluation Form
go to the Project SEED program Description
go to the Student Science Enrichment Program

Application Form

American Chemical Society's PROJECT S.E.E.D./R.E.A.P. Program

Social Security Number:
Zip Code
Evening Telephone Number
Are You A U.S. Citizen?
If you're not a U.S. citizen, state your country, citizenship, and type of visa you hold.

Racial or Ethnic Origin
Religious Denomination (optional)
Date of Birth
Place of Birth
Area of Science Interest
Email address
Describe any disability of which you are aware.

Name of Parent or Guardian
Street address

Name of High School
Street Address
Name of High School Counselor
Phone Number of High School Counselor

PSAT Scores: Math/Verbal
SAT Scores: Math/Verbal
ACT Scores: Math/Verbal
Overall GPA:
Class Rank

List academic honors, prizes, scholarships, or extra-curricular activities, hobbies and special interests. Indicate any leadership positions held.

What are your plans for post graduate/professional training? Please indicate by checking off the following.

Graduate school to pursue
Ph.D in science/engineering
Graduate School to pursue
M.S. degree in science/engineering
Medical school
Other health professional program

List High School Science and Mathematics courses which you have completed and provide a numerical average for each course.

Number of Brothers
Number of Sisters
If you have any list all serious illnesses, chronic illnesses, and significant allergies

Describe how you've spent your last two summers.

Father's name(last, first, middle)
Is he living?
His occupation?

Father's Approximate Income Range - This information is required to insure program eligibility. Please check the appropriate financial income range.


Mother's Name(last, first, middle)
Is she living?
Her occupation
Mother's Approximate Income Range - This information is required to insure program eligibility. Please check the appropriate financial income range.

Write an essay (2-3 paragraphs) describing your interest in science and your career goals. Include a discussion of any research or science fair projects in which you have participated as high school student.

How can this program benefit you? (please write approx. 250 words)

I certify that all of the above statements are true.
Once you have submitted your application, Kenneth Cutler, Project SEED Director, will contact you either by phone or by email.

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