Build A Human

Funded by Howard Hughes Medical Institute

STUDENT INFORMATION AND APPLICATION

Your application will not be considered without the following items:

Deadline for submitting application:  April 1, 2003

1.  A copy of your most recent report card.

2.  Two letters of recommendation (one must come from a teacher or counselor).

3.  A one-page personal statement of why you want to participate in this program.                      This MUST be typed.  Correct grammar and spelling are important.

For further information or to send  application with two letters of recommendation, copy of your most recent report card and one-page personal statement to:

Dr. Lynne Houtz, Education Department, Creighton University, 2500 California Plaza, Omaha, Nebraska  68178-0106

Phone # (402) 280-2247/ E-Mail: lhoutz@creighton.edu

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STUDENT APPLICATION FORM:

Name: _________________________________________________________________________________

Address: _______________________________________________________________________________

City: ________________________________ State: _______________________ Zip: __________________

E-mail: ________________________________________________________________________________

Home Phone #: __________________________________________________________________________

School: ________________________________________  Grade: _________________________________

Gender:        ____Male        _____ Female

Ethnicity:

  • African-American

  • Asian-American

  • Hispanic

  • Native People

  • White/Caucasian

  • Other (please specify) __________________________________

Do you qualify for free or reduced lunch?    _____ Yes      _____ No

Overall Grade Average: ______________

Science Grade Average: ______________

How did you find out about this program?

  • Teacher   

  • Recruiter

  • Counselor

  • Brochure/Notice

  • Newspaper

  • Internet

  • Other

 

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