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Supplemental Application for the Campus College Connection STEM Major Summer Bridge Program

Name (required):

Address:

City, State and Zip Code :

Cell Phone (required):

E-mail address (required):

Date of birth (required):

Gender:

Male | Female

Check all of the items listed below that apply to you:
African-American
Asian-American
Caucasian
Hispanic
Native-American
Other:

I am the first member of my family to attend college in the United States

"For the next two questions, please respond in 300-500 words. You may copy and paste your answers from a separate word processing application if you wish."

I. In the space below, either:
a) Briefly describe a "eureka moment' you've experienced in your life.
Or
b) Briefly describe a time when you encountered a really tough problem and solved it.

II. Briefly tell us what you hope to be doing in ten years.