SI 2016 Application

Page One

SUMMER INSTITUTE 2016 APPLICATION Student Academic Services logo

JULY 30th - AUGUST 23rd, 2016

*Before submitting your application, please save a copy of your essay in a Word document

Full Name: *This question is required.

Cal Poly Username (your username is before the "@calpoly.edu" of your Cal Poly email address:) *This question is required.

@calpoly.edu

1. Mailing address in June/July:

Street Address

City

State

Zip

Phone Number

2. College credits completed by the time you start Summer Institute

List the AP exams you have or will be taking:

Enter any other AP exams you have or will be taking:

Other AP
Other AP

List courses you have taken and passed at a community college or university, if any:

Space Cell	Course	College Name
1	1: Course	1: College Name
2	2: Course	2: College Name
3	3: Course	3: College Name

3. Financial Aid (To be provided to all SI selected EOP students whose eligibility is verified)

4. Are there any special accomodations needed to assist you; e.g. mobility assistance, sign language interpreter, specific dietary needs, transportation to and from airport, bus or train station, etc.?
If so, please describe:

5. Based on the following prompt, write a short essay (approximately 250 words):
"Why I'm interested in attending Summer Institute and how I plan to benefit from this experience." *This question is required.

* Once you submit your application, a confirmation message will appear on your screen.