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.