July 21 - 25, 2008 Michigan State University
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Information about you
First Name:
Last Name:
Email:
Phone:
Home address street:
City: State: ZIP:
Age:
Birthday:
Gender (optional): Male Female
US Citizenzhip: Yes No
Information about your school
School Name:
School District:
School Phone:
School address street
Information about your background
Grade Level Next Fall: Sophomore Junior Senior College Please list all classes in science and math you have taken. Note that there are no required courses for this program. Please give a brief listing of previous work experience, including the dates worked, the employer and a job description. Please list any other experience you have which you feel make you a good candidate for this program. Please state briefly why you are interested in the PAN program. You can also send your personal statement to PAN, or e-mail it separately. Letters of reference
Please have one science or math teacher and one teacher of any subject write a brief letter of reference to PAN. These letters of recommendation may be directed to PAN by U.S. post, by e-mail, or by telephone (see Contact PAN for addresses). Please list the names of the teachers who will be writing the letters for you.
First teacher's name
School
Second teacher's name
Accommodations
Do you plan to stay on campus?
If no, please tell us how you will get to MSU and where you will stay.
Survey
How did you first learn about the PAN program?
Poster The PAN website
Another website (please specify): Other (please specify):
