Welch Summer Scholar Program 2019 Student Application
All application materials are due February 15, 2019 by 5:00 p.m. Student notifications will be e-mailed approximately mid April.

NOTE: Please make sure you complete the entire application accurately and in the correct format before submitting. Erroneous or incorrectly entered information may cause your application to be discounted. Please make sure that the name on your supporting documentation matches your application.

If you have any questions please email Brenda Baxendale at wssp@cm.utexas.edu.

Last Name, First Name, M.I. [NOTE: PLEASE ENTER YOUR NAME IN THIS ORDER -- (LAST NAME FIRST, FOLLOWED BY FIRST NAME THEN MIDDLE INITIAL)] *
Your answer
High school currently attending *
Please include city
Your answer
Current grade *
Complete home address (Street, City, Zip). DO NOT FORGET TO INCLUDE YOUR CITY *
Your answer
Telephone Number ** PLEASE ENTER AREA CODE FOLLOWED BY NUMBER IN THIS FORMAT: (xxx) xxx-xxxx ** *
Your answer
Birthday (mm/dd/yyyy) *
Your answer
Email Address *
Your answer
Gender *
Total SAT or PSAT Score ** PLEASE INDICATE TEST TYPE FOLLOWED BY SCORE ** *
Please enter the cumulative score only, and indicate whether SAT or PSAT.
Your answer
What degree do you plan to earn in college? *
(ex. BS in Biology)
Your answer
How did you hear about WSSP? *
Your answer
Important: Please describe any special dietary requirements or physical needs you may have so that we may effectively and properly accommodate *
Your answer
Ethnicity (Answers to this question will be held confidential and will not in any way affect your acceptance into the program)
If you would like us to be aware of a specific area of interest or experience in chemistry that you have, please describe it briefly.
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of UTmail.