PA3 Summer Bridge Program Application Form
Program dates: July 12 - August 9, 2014
Instructions: Please complete this form in full by May 10, 2014. Make sure you proof-read your application before submission.

In addition to this application, please submit your most recent transcript and a recommendation form from your teacher using this template: http://tinyurl.com/PA3-TeacherRecommendation.

Note for high school students: please ask your math, English, social studies, or science teacher for a recommendation.
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First Name: *
Last Name: *
Address: *
City of Residence: *
Phone Number: *
Contact Email: *
Emergency Contact Name: *
Emergency Contact Phone Number: *
Emergency Contact Email: *
Relationship to Student: *
Your current grade in high school: *
High school or college that you are currently attending: *
Seniors only: College that you will be attending in the Fall 2014.
Others, please state NA.
What are your current academic interests or intellectual curiosities? *
Please name up to 3 academic interest and/or possible or currently declared majors in college and elaborate.
In the course of this past academic year, what books have you read that were assigned to you in school? *
In the course of this past academic year, what books or publications have you read that were NOT assigned to you in school? *
Please tell us what you found meaningful about one of the above-mentioned books or publications. *
Your answer should be at least 250 words.
Why are you interested in participation in the PA3 Summer Bridge Program? *
Please provide a well-reasoned thoughtful response.
What other activities will you or do you plan to participate in this summer? *
Please list all the activities you will be engaged in, including summer job, camps etc, and when they will be running.
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