Complete ALL fields and click to submit.

PERSONAL INFORMATION

Last Name

First Name

Middle Name Birthdate

E-mail Address Local Phone

Local Address(include address, city, state, zip)

Permanent Home Address (include address, city, state, zip)

Home Phone

Citizenship Status U.S. Citizen Permanent Resident Student Visa

EDUCATIONAL INFORMATION

Major Area of Study (Choose One) Biocomputer Engineering Bioelectronic Engineering Biomechanical Engineering Civil Engineering Environmental Engineering Electrical Engineering Electronic Option Electrical Engineering Computer Option Computer Engineering Mechanical Engineering

Expected Area of Concentration

Overall GPA Academic Classification Sophomore Junior

Credits Completed Current Credit Load

Career Goals


High School Name

High School Location (city,state)

Dates Attended (from MO/YR to MO/YR)

Class Rank (rank/number of students in class)

GPA (out of 4.0)

High School Extra-Curricular Avtivities, Organizations and Honors

If you have attended another college or university please provide informnation on name, location, dates attended, class rank and GPA.


EMPLOYMENT AND BUSINESS EXPERIENCE

(include significant permanent, part-time, volunteer, military and summer work). Provide employer/employers name and address, description of work, hours worked per week and dates of employment.


GENERAL INFORMATION

Other Information: College/Community activities, hobbies, interests . . .


Signature MU ID Number

Date