3 step Application Process:
1. Submit online application
form (Below).
2.Paper Application
Print the above paper application and Submit
signed original application. Paperwork submitted and received by
5.00 p.m., May 16, 2008 (not postmarked). Paperwork should be mailed
at the following address:
Chastity Harper
NC-MSEN Pre-College Program
The Center for Mathematics, Science, and Technology Education
College of Education Building, Suite 222, UNC Charlotte
9201 University City Blvd.
Charlotte, NC 28223
3. Receive mail confirmation of
your acceptance into The MSEN Pre College Program (June).
Student Information
What is your status with the NC-MSEN Pre-College Program?
Last Name
First Name
MI
Grade Level (Fall 2007) Gender
Birth Date (mm/dd/yy)
Address
City
State
Zip Code (99999)
Home Phone Number (999-999-9999)
Student Email Address
Race/Ethnicity
T-shirt Size
Parent Information. Please type "private" in the spaces
provided if one parent's information is unavailable.
Female Guardian's Name (First Name Last Name)
Female Guardian's Work Phone Number (999-999-9999)
Female Guardian's Occupation
Female Guardian's Email Address
Male Guardian's Name (First Name Last Name)
Male Guardian's Work Phone Number (999-999-9999)
Male Guardian's Occupation
Male Guardian's Email Address
Secondary Contact's Name (First Name Last Name)
Secondary Contact's Home Phone Number (999-999-9999)
Secondary Contact's Work Phone Number (999-999-9999)
Secondary Contact's Email Address (optional)
Secondary Contact's Relation
Academic Information
How many years have you been in this program?
Current School (Spring 2008)
School you will attend during the Fall 2008
What science courses are you enrolled in for the following semesters?
Spring 2008
Fall 2008
What math courses are you enrolled in for the following semesters?
Spring 2008
Fall 2008
Educational Goal
We, the student and parent, have read the policies and regulations of the
Pre‑College Program and hereby accept these policies and regulations described
therein. We understand that the campus has the authority to establish and
enforce other regulations in addition to the Pre-College Program's policies
and regulations.
We understand that failure to abide by the University of North Carolina at
Charlotte and the Center for Mathematics, Science, and Technology Education
policies and regulations may lead to the student's dismissal from the
Program. We understand that the director of the Program has the authority to
dismiss the student for behavior that is not specifically covered in the
Pre-College Program's policies and regulations, but which is contrary to the
educational goals of the Pre‑College Program. Finally, we understand that in
the case of violations covered by state law, the Pre‑College Program staff is
legally required to report the violations to local law officials for handling.
We have personally supplied this information and I attest that it is true
and complete to the best of my knowledge. We hereby give my permission to any
doctor, hospital, or other medical agency to release confidentially to the
Student Health Service Physicians or Nurse Practitioners of the University
of North Carolina at Charlotte's Brocker Health Center any information that
they may have concerning my medical condition and their professional contact
with me. I further authorize Brocker Health Center to release to any doctor,
hospital, or other medical agency providing medical service to me and any
information they may have concerning my medical condition and their
professional contact with me.
By submitting this application, I hereby agree to the terms disclosed above
for the NC-MSEN Pre-College Program. I do understand that my
application is not complete until I submit the requested information below.
Important: The following items must be
received at the NC-MSEN Pre-College program at UNC Charlotte no later than Friday, May 16, 2008
at 5.00 p.m. with no exceptions:
-
Printed copy of confirmation form with parent and student
signatures and additional information required..
-
Copy of the student's 1st semester report card and 3rd
quarter report card.
-
Recommendation from math teacher, science teacher, or school
administrator (only one recommendation -
click here for recommendation form)
-
One-page, student-written essay describing why the student wants to participate in the
NC-MSEN Pre-College Program (minimum of 100 words), preferably
typed, 12 font, 1 inch margins, with the students name in the upper right-hand
margin.
Your application packet
will be reviewed and your acceptance into the program will be
confirmed by a letter mailed in June 2008.
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application above. If you do not have Adobe Acrobat Reader, click here to
Download The Adobe Acrobat Reader.