A. Personal Information (items marked with * are required):
1. Name*: ______________________________
2. Social Security No.*: _______________________
3. Date of Birth*: ________________________
4. Citizenship* (check one): U.S. Citizen____ Permanent Resident____ Other____
5. Demographic Information:
a) Gender: Female____ Male____
b) Ethnicity/Race: Hispanic / Latino____ American Indian / Alaskan Native____
Asian____ Black / African American____
Native Hawaiian / Pacific Islander____ White____
6. Home Address (include E-mail, if any)*:
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7. School Name and Address (include E-mail, if any)*:
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8. Telephone numbers*:
Home: _________________________ School: _________________________
9. Names of Refereneces*:
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B. Academic Background (items marked with * are required):
1. Current cumulative GPA*: _______________
2. Major*: ________________________________________
3. Number of credit hours completed*: _______
4. Classification in Fall 2010 semester* (check one): Sophomore____ Junior____ Senior_____
5. Academic and Extra-Curricular Accomplishments (including awards, prizes, scholarships):
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6. Briefly explain any team work or group project you have been involved with:
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7. Computer Systems, Programming Languages, and Operating Systems Experience:
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C. General:
1. Career Goals: ____________________________________________________________________________
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2. Memberships in clubs, groups, and societies:
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3. Please indicate any additional information which you consider to be helpful for your application:
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