Research First Application Form

First Name: Last Name:
Email: Telephone:
Address: City:
State: Zip:
High School: Chemistry Teacher:
SAT Math: SAT Verbal:

High School Science Courses (Please check all courses taken, to be taken, or in progress.)
Chemistry
Biology
Physics
Geometry
Calculus
Biochemistry
Advanced (AP) Chemistry
Advanced (AP) Biology
Algebra 2
Trigonometry
AP Calculus
Organic Chemistry

Laboratory Techniques (Please check those with which you have worked.)
Preparing Solutions
Titrations
Chromatography
pH Meter Measurements
Spectrophometers
Gas Chromatography

Career Plans (Briefly list possible career interests):
Possible Start Date: Possible Finish Date:

Planned Summer Vacations (Please provide date ranges):