Office of the Provost Collegiate Science and Technology Entry Program

Application Form | The Collegiate Science and Technology Entry Program Submit application by mail, fax, or hand delivery to: Fordham University | CSTEP Program Rose Hill Campus | Collins Hall, Third Floor | 441 East Fordham Road | Bronx, NY 10458 | Phone: (718) 817-3265 | Fax: (718) 817-3263 Lincoln Center Campus | Lowenstein 1115E | 113 West 60th Street | New York, NY 10023 | Phone: (212) 636-7122 | Fax: (646) 312-8797

Student Information Full Name

Home Address Apt.

City State ZIP code

Fordham ID Number

Home Phone Cell Phone

Fordham E-mail Personal E-mail

Campus Mailing Address/University P.O. Box

Residence Hall Campus Extension

Gender Male Female Date of Birth

New York State Resident Yes No HEOP Student Yes No

Were you a STEP student? Yes No If yes, specify STEP program

Ethnicity African American/Black Alaskan Native Hispanic/Latino Native American Other* (please specify) * Income documentation required for students who do not meet the program’s ethnic criteria. Please provide information below.

Financial Information If applicant is not African American/Black, Alaskan Native, Hispanic/Latino, or Native American, please fill in the following information and provide a copy of the most recent income tax return. Refer to chart in this brochure to determine eligibility.

Family Income Number in Household

Source(s) of Income

Financial Aid Tuition Assistance Program (TAP) Pell Grant Stafford Student Loan College Work Study Grant Fordham Tuition Award

Merit Scholarship University Presidential Scholarship Gates Millennium Scholarship Loyola Scholarship

Other programs (please specify)

Other scholarships High School Information School Name

City State ZIP code

Grade Point Average Class Rank

Standardized Test Scores SAT Math Critical Reading ACT

Transfer Student Information (if applicable) College/University

City State ZIP code

Degree Grade Point Average Dates of Attendance

College Information School enrolled within Fordham University Gabelli School of Business Fordham School of Professional and Continuing Studies Fordham College at Lincoln Center Fordham College at Rose Hill

Academic Standing  Full-Time Part-Time Freshman Sophomore Junior Senior Graduate Student

Specify graduate program

Cumulative Grade Point Average Credits Completed Expected Year of Graduation

Major(s)

Minor(s)

Pre-Professional Program/Field of Interest Accounting Dentistry Computer Science Engineering Law Math Education Medicine Optometry Podiatry Psychology Science Education Social Work Veterinary Medicine Other

How did you hear about the CSTEP Program? Dean or other Administrator

Faculty Member

CSTEP Student

Mailing

Recruitment Events

Other

For Office Use Date Received Accepted Declined Waitlisted Date

Comments

New York State CSTEP Student Fordham CSTEP Student Summer Scholar