APPLICATION FOR DEPARTMENT OF BIOLOGY HONORS PROGRAM
1. Name______Date ______University ID______
Last First Middle Circle: Mr. Ms.
initial
2. Circle preferred address and telephone number:
a) Home address ______Home phone ______
______
b) School address ______School phone ______
______
c) E-mail address ______Alt. email ______
3. Present academic status (circle appropriate year and semester):
Year Freshman Sophomore Junior Senior
Semester 1st 1st 1st 1st
2nd 2nd 2nd 2nd
4. Major ______Area of specialization ______
5. Are you or have you been a member of the University Honors Program? ______
6. Expected date of graduation ______
7. A prerequisite for participation in this program is the sponsorship of a faculty member who has agreed to advise you in your future course work and who will direct your research project. If your mentor is off campus, specify an on-campus co-mentor (you may need to discuss this with the Director of the Biology Honors Program). Please provide the name, complete mailing address (including name of Department or Institution), email address and telephone of your mentor and, if appropriate, co-mentor.
Mentor: ______Co-Mentor: ______
Department: ______Department: ______
Institution: ______Institution: ______
______
Email address:______Email address:______
Telephone(s): ______Telephone(s): ______
Signatures:
Mentor: ______Co-Mentor: ______
Date: ______Date: ______
8. a) University of Maryland G.P.A. (grade point average) in all course work to date: ______
b) G.P.A. in biological sciences: ______
c) G.P.A. in chemical and physical sciences: ______
d) Academic Record: (include present registration)
Biology Courses Supporting Courses (chem., physics, math, stat., com. sci., psych., etc.)
Course Title Grade Course Title Grade
9. High School or College Academic Awards or Scholarships:
10. Were you ever associated with, or did you take an active part in any High School or college honors
curriculum or science project? Explain.
11. What are your major academic interests outside of the biological and physical sciences?
12. What are your long term goals and career objectives?
13. Why are you submitting this application for candidacy in the Biology Honors Program?
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