Land Grant Program Pathways & Access to Careers in Technology Summer Program

June 8-14, 2008

Application Packet

_____________________________________________

APPLICATION PACKET DUE: February 25, 2008

Eligibility:

·  Students who will have completed the 5^th, 6^th, or 7^th grade by June 8, 2008

·  Students who are at or above grade level as reported by school records

·  All application materials must be submitted by the posted deadline.  Materials submitted after the posted deadline will not be accepted and may result in disqualification of the applicant

Please Note: *Not all qualified applicants will be admitted due to space constraints.

The information submitted will be used to evaluate your student for admittance and pre-registration into the 2008 PACT Summer Program.  Please complete the form and submit it on-line or mail a completed hardcopy, using blue or black ink (print only) to the following contact: 

Attn:  Mrs. Rachael Steward

Chappell Building: PACT Summer Program

400 E. Main Street

Frankfort, KY 40601

Email: rachael.steward@kysu.edu

Fax: 502-597-6763

Phone: 502-597-5585

Essay Question:  Submit with the student’s application form a 200-250 word essay (typed, double -spaced) responding to the appropriate question/prompt listed below. The essay should be the student’s own work reflecting their genuine interest and writing ability.   

1.       New Applicants: What do you want to be when you grow up and why?  How does your career goal relate to technology?

2.       Previous Participants: Describe your use of science and math outside of school.

Report Card: A copy of a report card from the 2007/2008 school year must be provided. 

Student Information

First Name:                    Last Name:

Date of Birth:                                 Age:

Gender: male female

Ethnicity*:

Street Address:

City:         State:   Zip Code:

Home Phone:     Alternative Phone:

School Name:

School Address:

Current Grade in School: Current GPA:

Parent/Guardian Information

First Name:                     Last Name:

Relationship:     E-Mail Address:

Street Address:

City:         State:   Zip Code:

Home Phone:     Alternative Phone:

1.       Has your child participated in a prior PACT Summer Program? yes no

2.       Has your child participated in any other Kentucky State University programming? yes no

If yes, please provide the program name and year of attendance:

3.       How did you learn about the PACT Summer Program? School Presentation, Church or other community organization, Postal Mail, Flyer, Word of Mouth, Newspaper, TV, Other:

4.       Does your child automatically qualify for any other program offered in Summer 2008?   yes no   If so, list here.

5.       Has your child already been admitted to another program offered in Summer 2008?  yes no

6.       Do you certify that the essay submitted is predominantly your child’s effort?  yes no

7.       Has your child previously participated in a summer program at any other university?  yes no  If so, list the universities:

8.       Do you have a relative working for Kentucky State University?  yes no 

If yes, please provide the individual’s name and position:

* ETHNICITY INFORMATION IS VOLUNTARY AND WILL NOT BE USED FOR PROGRAM ACCEPTANCE.  IT WILL BE USED FOR DEMOGRAPHIC REPORTING TO FUNDING SOURCES.