A. Personal Information:
1. Name: ______________________________
2. Social Security No.: _______________________
3. Date of Birth: ________________________
4. U.S. Citizen/Permanent Resident: Yes No
5. Home Address:
_______________________________________________________________________________
_______________________________________________________________________________
6. School Name and Address (include E-mail, if any):
_______________________________________________________________________________
_______________________________________________________________________________
7. Telephone numbers: Home: ______________________
School: _________________________
8. Names of Refereneces:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
B. Academic Background:
1. Current cumulative GPA: _______________
2. Major: ________________________________________
3. Number of credit hours completed: _______
4. Classification in Fall 2004 semester: Sophomore Junior Senior
5. Academic and Extra-Curricular Accomplishments (including awards, prizes, scholarships):
____________________________________________________________________________________________
____________________________________________________________________________________________
6. Briefly explain any team work or group project you have been involved with:
____________________________________________________________________________________________
____________________________________________________________________________________________
7. Computer Systems, Programming Languages, and Operating Systems Experience:
____________________________________________________________________________________________
____________________________________________________________________________________________
C. General:
1. Career Goals: ____________________________________________________________________________
____________________________________________________________________________________________
2. Memberships in clubs, groups, and societies:
____________________________________________________________________________________________
3. Please indicate any additional information which you consider to be helpful for your application:
____________________________________________________________________________________________
____________________________________________________________________________________________