Download Phone: --------- Email - Tarleton State University

Tarleton 2017 Physics Camp
Application
First Name, Last Name (Print):
Mailing Address:
Phone:
---------
Age as of June 18, 2017:
Email:
-
High School: -
Circle Your Grade in High School For Fall 2017:
Fr
So
Sr
Jr
Is your parent a current or former member of the military?
Y
N
Are you a Foster Child?
Y
N
Circle The Course You Have Completed:
Algebra I
Geometry
Algebra II
Pre-Calculus
Biology
Chemistry
Physics
AP Physics
If you took Physics/AP Physics, what was your teacher's name:
Did you participate in UIL Math/Number Sense/Science Competition?
Y
If yes, list the events you participated and any awards?
Have You Been On Tarleton Campus:
y
N
Rank Your Interest In the Camp's Physics Tracks (1 highest & 5 lowest):
Astronomy/Astrophysics
Medical Physics
Physics of Optics/Lasers
Physics of Electronics
Nuclear Physics
N
Name of Teacher/Counselor Writing Letter of Recommendation:
_
What are your educational & career goals and how do you think that participating in the camp will
help you achieve these goals:
Return Completed Application & Demographic Sheet as Email Attachment or by Mail:
Dr. Daniel K. Marble, Tarleton Physics Camp
Box T-540
Tarleton State University
Stephenville, Texas
76402
[email protected]
Letters of recommendation may be submitted electronically as an email attachment or mailed to
Dr. Marble.
Student & Household Demographics
The following information is collected for reporting purposes to the Texas Work Force
Commission a s p a r t o f o u r g r a n t and will not be used in the selection process.
Student Ethnicity:
White/Caucasian
African American
Hispanic
Asian
Native American
Other
Number of People in Household:
Father's Education (circle):
_
High School
High School Graduate
College
College Graduate
Advanced Degree
Mother's Education (circle): High School
College
High School Graduate
College Graduate
Advanced Degree
Family Income (Circle):
< $25,000
$25,000 - $49,999.99
$50,000-$74,999.99
$75,000- $99,999.99
$100,000 - $124,999.99
$125,000-$150,000
> $150,000