Math FOCUS Application : Developmental Mathematics : Texas State University

Applications are no longer being taken for Summer 2008.

Date: *

Student's Name: *

Date of Birth:(mm/dd/yyyy) *

Participants 18 or younger:

Parent/Guardian’s Name
E-mail Phone
Parent/Guardan's Mailing Address

Participants older than 18:

Permanent E-mail Phone
Permanent Address

All participants

Local E-mail Phone
Local Address

Gender: *

Male

Female

If other race/ethnicity please specify:

Primary Language Spoken at Home: *

English

Spanish

Other

If other primary language spoken please specify:

Educational Attainment of Parents/Guardians
(check the highest level completed)

Mother/ Female Guardian	No High School	Some High School	High School Graduate	Some College	Bachelors Degree or higher	Don’t Know/ Not Applicable
Father/ Male Guardian	No High School	Some High School	High School Graduate	Some College	Bachelors Degree or higher	Don’t Know/ Not Applicable

List the following

Extracurricular activities in high school (example - sports, choir, school newspaper):
High School:

College/Univerisity:

Awards and/or Honors (example – placing in academic competition, honor roll etc.):
High School:

College/Univerisity:

Community Service Activities (example – volunteering with homeless, tutoring younger students, etc.):
High School:

College/Univerisity:

Check the best answer.	Strongly Agree	Agree	Not Sure/ Neutral	Disagree	Strongly Disagree
I plan to go to/continue in college
My parents/guardians encourage me to go to college.
My friends plan on/are going to college.
I enjoy school.
My high school teacher(s)/counselor(s) care(d) if I go/went to college.
I am interested in a specific college(s). Please specify:
I have a specific career goal(s).

Check appropriate answer.

Did you or any member of your family qualify for the free or reduced lunch program during the 2007-08 school year? *

Yes

No

Not applicable/Don't want to answer

In Fall 2008-09, I plan to attend college: *

Part-time (3courses per term or less)

Full-time (4 or more courses)

Not attending

Eligible for Pell Grant? *

Yes

No

Don't Know

If other graduation plan please specify:

Year diploma/GED received:

Graduating High School City, State ISD

Please describe why you should be considered for the program(100 words or less). *

Please describe how you will show your commitment to this program(100 words or less). *

Please provide a Nominating Reference:(A nominating reference can be anyone who can attest to your commitment to the program.)

Name: *

Title and Organization: *

Relationship to Reference: *

Phone Number: *

Email: *

If other, please specify:

Consent (English)

Texas State University-San Marcos and the Texas Higher Education Coordinating Board are using student data to evaluate the effectiveness of this program. All data is confidential. It will be reported only in the aggregate and for the express purpose of measuring and reporting on the effectiveness of this program.

I understand that any such information will be used by Texas State University-San Marcos and the Texas Higher Education Coordinating Board only for these purposes, that Texas State University-San Marcos and the Texas Higher Education Coordinating Board will not disclose any such information that personally identifies a student to any other party, and that any report generated on the basis of this information will not personally identify any student.

Consentimiento (Español)

Texas State University-San Marcos y la Junta Coordinadora para la Educación Superior en Texas están usando los datos de los estudiantes para evaluar la efectividad de este programa. Todos los datos son confidenciales. Sólo serán informados de manera agregada y con la finalidad expresa de medir e informar la efectividad de este programa.

Yo/Nosotros comprendemos que dicha información será usada por Texas State University-San Marcos y la Junta Coordinadora para la Educación Superior en Texas solamente para estos fines, que [institución] y la Junta Coordinadora para la Educación Superior en Texas no darán a conocer a ninguna otra parte, ninguna información que identifique personalmente a un estudiante, y que cualquier informe generado en base a esta información no identificará personalmente a ningún estudiante.

Agree/Acepto

Disagree/No Acepto

College of Health Professions

Developmental Mathematics

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Math FOCUS Application

Applications are no longer being taken for Summer 2008.