2008 Out-Of-State Applications



Name and Address

______________________________________________________________________
First Middle Last

______________________________________________________________________
Street Address

_______________________________________________________________
City State Zip Code

e-mail: _______________________________________________________________

phone: _______________________________________________________________

Gender:   Male ___     Female ___

Specify Cultural Designation (optional):
Caucasian ___, Asian ___, Native American ___, Eskimo or Aleut ___,
Asian/ Pacific Islander ___, Black / African American ___, Hispanic/ Latino___

U.S. Citizen or Permanent Resident:   Yes ___     Other __________________________

High School _______________________________________________________________

___________________________________________________________________________
City State Zip Code

Check Current Academic Status:
  Sophomore ___     Junior ___     Senior ___

Cumulative Grade point average: ______________

Please indicate your top 3 areas of interest in order of preference:

___ Biomedical
___ Civil & Envir. Engineering
___ Computer Science
___ Electrical & Computer Engineering
___ Materials Science
___ Mechanical Engineering
___ Mathematics
___ Statistics


Other ______________________________

Please send a copy of your high school transcript or report card with your application.

I have enclosed a deposit of $690 (towards the $990 program cost) that will be refunded if I am not admitted to the program: _____

I learned about this program from ________________________________________________________.

Return application to:
Dawn Densmore, Director
College of Engineering And Mathematical Sciencies
101 Votey Hall, Burlington, VT 05405-0156
Phone: 802-656-8748
FAX: 802-656-8802
E-Mail: densmore@cems.uvm.edu
Web site address: http://www.cems.uvm.edu/summer
Approval for Program Participation: