PIXE-PAN 2009 Student Application

DATES TBA

University of Notre Dame

Information about you

First Name:

Last Name:

Email:

Phone:

Home address street:

City: State: ZIP:

Information about your school

School Name:

School District:
   

School Phone:

School address street

City: State: ZIP:

Information about your background

Grade Level Next Fall:

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 PIXE-PAN program. You can
also send your personal statement to PIXE-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 PIXE-PAN. These letters of recommendation may be directed to PIXE-PAN by U.S. post, by e-mail (mdewitt@nd.edu), or by telephone (see Contact PIXE-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

School

Accommodations

We are not able to provide housing for students for PIXE-PAN @ ND. If you do not live within commuting distance, please indicate where you will be staying locally.