MEPHonors Partnership APPLICATION
This application can be used to apply for a MHP Fellowship with any of the following four
universities: CSU Sacramento, CSU San Jose, UC Davis, or UC San Diego
Please TYPE or PRINT all information on sections 1 through 8 of this application
and return with an unofficial copy of your school transcript to:
MEP Honors Partnership
CaliforniaStateUniversity, Sacramento
Sacramento, California95819-6023
Also, two MHP Recommendation Forms must be completed and returned (see instructions on Recommendation Form)
Priority is given to applications received by January 31
1. Personal Information
Name ______Social Security # ______
Address ______City______State______Zip______
Home phone (___)______Message phone (___)______E-mail address______
Ethnicity (optional): African-American ___ Mexican/Puerto Rican/Latino _____
American Indian (please list tribal affiliation): ______Other: ______
Are you a U.S. citizen? Yes___ No___
If no, do you have the legal right to work permanently in the U.S.? Yes ___ No ___
2. Educational Information
School/College/University currently attending: ______
Cumulative GPA: ______(4.0 scale) (High School students only) SAT score: verbal ______math ______
ACT score: verbal ______math ______
(High School or Community College Students Only)
Expected Date of graduation or transfer from current school (month/year) ______
Have you submitted an application to: CSU Sacramento_____ CSU San Jose____ UC Davis____ UC San Diego____
College Major: Computer Science___ Computer Engineering___ Mechanical Engineering___ Civil Engineering ___
Electrical Engineering___ Chemical Engineering___ Aerospace Engineering___ Other______
(If undecided between two or more majors, check more than one.)
(High School students only)
Check courses completed or completing: Trig_____ Pre-Calculus_____ AP Calculus _____ Calculus___ Chem ____
APChem___ AP Physics ___ Physics___ Computer Programming___
(College Students Only)
List courses completed in:
Math: ______
Science: ______
Technical Skills Proficiency
List special skills (ie., word processing applications, web page design, autocad, drafting, database management): ______
Please list any activities that demonstrate your interest in math or science: ______
______
3. Academic Organizations/Honors
MESA___ MEP___ UC Early Outreach Partnership___GATE ___AISES___NSBE___SHPE___
National Merit Scholar: ____ Governor’s Scholar: ____
Other scholarships, honors and extra-curricular activities: ______
______
4. Internship Assignment Information
Do you have any conflicts that prevent you from working during school breaks? Yes ____ No ____ If yes, explain: ______
______
Is there an employer that you have always wanted to work for? Yes ____ No ____
If yes, name of employer(s): ______
Where would you prefer to work?: San Diego______Bay Area______Sacramento______Other______
5. Work Experience Information
Provide information on any paid or non-paid positions you have held.
Position: ______Employer: ______
Supervisor: ______Phone #: (___) ______
Dates (mo./yr.): From: _____/_____ to: _____/_____
Duties/Accomplishments: ______
______
Position: ______Employer: ______
Supervisor: ______Phone #: (___) ______
Dates (mo./yr.): From: _____/_____ to: _____/_____ Duties/Accomplishments:______
6. Applicant Recommendations
Provide Information on the two individuals you asked to complete applicant recommendations:
(See instructions on applicant recommendation form.)
Name: ______Title: ______Phone #: (___) ______
Email:______Organization: ______
Name: ______Title: ______Phone #: (___) ______
Email:______Organization: ______
7. School Transcript
An unofficial (or official) copy of a legible transcript from the school you are now attending must be attached to this application.
8. Personal Statement (please keep responses limited to this page.)
Why are you interested in pursuing an engineering or computer science degree?
Explain how your family and/or community have influenced your school life and personal growth and how that influence might shape your future.
Describe a time you were very proud of yourself for something you have accomplished which required a great deal of time and energy. How did you accomplish this?
Describe a time in high school or college when you enjoyed learning or when learning inspired you.
Your name (print) ______Signature______Date______
MHP Fellowship
RECOMMENDATION FORM
Provided by Applicant
Instructions to applicant: Give this form to a teacher or professor who knows you well enough to evaluate your qualities and abilities. Both of the required recommendation forms must be completed by a math or science teacher or professor. Also, provide that individual with a stamped envelope, addressed to: MEP/MHP, California State University Sacramento, Sacramento, CA95819-6023.
Applicant’s Signature______Date______
Name (printed) ______Phone (___) ______
Address ______
City______State ______Zip ______
E-Mail Address: ______
Provided by math or science teacher or professor
I have known the applicant for a period of ____ years ____ months in my position as ______
Please rate the applicant in each of the following characteristics by circling the appropriate number.
1- Low 5- Average 10- High N- No Basis for Judgment
Motivation for School Work 12345678910 N
Initiative 1 2345678910 N
Enthusiasm in Math or Science12345678910 N
Cooperation/Teamwork12345678910 N
Dependability Completing Tasks/ Goals12345678910 N
Perseverance12345678910 N
Oral Expression12345678910 N
Written Expression12345678910 N
Leadership12345678910 N
Potential12345678910 N
Coachability (follows advice) 1 2 3 4 5 6 7 8 9 10 N _
I recommend this applicant: Not at all _____ Moderately _____ Enthusiastically ____
Additional Comments: ______
______
______
Please continue on the back of this form or attach letter of recommendation.
Name______Signature ______Date ______
School/College ______Phone (___) ______
Address ______City ______ZIP______Email: ______
PRIORITY IS GIVEN TO APPLICATIONS RECEIVED BY JANUARY 31
MHP Fellowship
RECOMMENDATION FORM
Provided by Applicant
Instructions to applicant: Give this form to a teacher or professor who knows you well enough to evaluate your qualities and abilities. Both of the required recommendation forms must be completed by a math or science teacher or professor. Also, provide that individual with a stamped envelope, addressed to: MEP/MHP, California State University Sacramento, Sacramento, CA 95819-6023.
Applicant’s Signature______Date______
Name (printed) ______Phone (___) ______
Address ______
City______State ______Zip ______
E-Mail Address: ______
Provided by math or science teacher or professor
I have known the applicant for a period of ____ years ____ months in my position as ______
Please rate the applicant in each of the following characteristics by circling the appropriate number.
1- Low 5- Average 10- High N- No Basis for Judgment
Motivation for School Work 12345678910 N
Initiative 1 2345678910 N
Enthusiasm in Math or Science12345678910 N
Cooperation/Teamwork12345678910 N
Dependability Completing Tasks/ Goals12345678910 N
Perseverance12345678910 N
Oral Expression12345678910 N
Written Expression12345678910 N
Leadership12345678910 N
Potential12345678910 N
Coachability (follows advice) 1 2 3 4 5 6 7 8 9 10 N _
I recommend this applicant: Not at all _____ Moderately _____ Enthusiastically ____
Additional Comments: ______
______
______
Please continue on the back of this form or attach letter of recommendation.
Name______Signature ______Date ______
School/College ______Phone (___) ______
Address ______City ______ZIP______Email: ______