APPLICATION FOR DEPARTMENT OF CBMG HONORS PROGRAM

1. Name                                                                    SI#                         Date                     
 	Last		First		Middle

2. a) Home address	                                                     Home phone                    

                                                    

   b) School address                                              School phone                    Email                   

3. Present academic status (year/semester): 	1st year	2nd year	3rd year

4. Are/were you a member of the University Honor's Program?           

5. Expected date of graduation                         

6. A prerequisite for participation in this program is the sponsorship of a faculty member who has agreed to direct and sponsor your research project.  If the mentor is off campus you must specify a CBMG faculty member as a co-mentor. You should discuss this with the Honors Program Coordinator.  Please provide the name, complete business mailing address, phone number and email address for your mentor and/or co-mentor.  If your mentor is not a CBMG faculty member, indicate their general field of expertise.  Please have your Mentor and Co-Mentor sign below.

Mentor:                                     Co-Mentor:                                        

Address:                                  		                                      

Phone:                           			                          

E-mail:                           			                          

General Field
of Expertise:	                                                                                                       		

Signatures:                                             		                                        

7.  Your Academic Record

  a) University of Maryland G.P.A. (grade point average) in all course work to date:       

  b) G.P.A. in Biological Chemical and Physical Science courses:       

  c) Record:  (include present registration and attach  a copy of current unofficial transcript)

Biol. Sci. Courses		Supporting Courses (chem, physics, math,)

Course Title 		Grade			Course Title			Grade

8. High School or College Academic Awards or Scholarships:

9. Were you ever associated with, or did you take an active part in any High School or college Honors curriculum or science project?  Explain.

10. What are your major academic interests outside the biological and physical sciences?

11. In an attached essay, provide a short description of your potential research project and explain what qualifications you have to perform this research (1 page maximum).