Summer Pathways Application

Name: Email address:

Street Address:

City: State: Zip:

Home Phone Number:

Cell Phone Number:


Date of Birth:

I will be a junior or senior in high school in September 2017 YES NO

I will be applying for financial aid YES NO

If yes, please read instructions

You must provide references from two teachers. Each teacher must submit an
online recommendation for you at

Please list the names of your two references and their email addresses here:

Name of Reference 1:
Reference 1 Email:
Reference 1 Phone:

Name of Reference 2:
Reference 2 Email:
Reference 2 Phone:

1.) List the science classes you have taken.

2.) List the math classes you have taken.

3.) List any science fair projects you have completed.

4.) List any extracurricular activities you participate in (clubs, sports, music etc.).

5.) List three reasons why you would like to participate in Summer Pathways.

6.) What benefits do you think you will gain from the program?

7.) Name three of your best qualities and explain how these qualities have helped you.

8.) What achievement of yours are you most proud of and why?