HINU | RISE | Student Research Application Form

HASKELL RISE PROGRAM

Student Research Application Form

(Please Print)

Name ____________________________________________________ Date of Application __/__/__

Tribal Affiliation ______________________ Advisor __________________ Date of Birth __/__/__

Major Area of Study ___________________ Haskell Degree sought: AA AS BA BS (circle one)

Expected Date for Completing Haskell degree Month _________ Year _________

1. Do you plan to obtain a BA or BS degree at Haskell? YES NO UNDECIDED (circle one)

If you answered YES, please skip to question 2.

If you answered NO or UNDECIDED, please answer questions 1.1 and 1.2 below.

1.1. Do you plan to get an AA or AS degree at Haskell? YES NO (circle one)

1.2. Do you plan to transfer to another college or university to obtain a BA or BS? YES NO

UNDECIDED (circle one)

If you answered NO or UNDECIDED, please skip to question 2.

If you answered YES, please answer questions 1.2.1 and 1.2.2 below.

1.2.1. Which transfer institutions are you considering? ______________________________

_____________________________________________________________________________

1.2.2. Which majors are you considering? _________________________________________

_____________________________________________________________________________

2. Do you plan to go to Graduate School? YES NO UNDECIDED (circle one)

If you answered YES, which degree will you be seeking? MS PhD Other (circle one)

3. If admitted to the RISE program, what kind of research would interest you? (If uncertain, list

more than one.) _____________________________________________________________________

___________________________________________________________________________________

4. What are your long-term career goals? _______________________________________________

___________________________________________________________________________________

5. Whom do you think of as successful scientists? (Who are your scientist role models?) _______

___________________________________________________________________________________

6. Have you ever thought about being a research scientist? YES NO (circle one)

7. What kind of science role interests you most? _________________________________________

___________________________________________________________________________________

8. Persistence is important in research and working in a laboratory. Give example(s) of a

position, activity, or opportunity that shows how persistent you can be. _____________________

___________________________________________________________________________________

What are your greatest strengths as a student/scholar? ____________________________________

___________________________________________________________________________________

10. What are your greatest weaknesses as a student/scholar? _______________________________

___________________________________________________________________________________

References (List 2 people you worked for or took classes from who are familiar with your skills.)

Name ________________________________________________ Phone ( ) _______________

Your College Address: Your Permanent Address:

___________________________________ ___________________________________

Campus Box # ______________________ ___________________________________

Phone # ( ) _______________ Phone # ( ) _______________

Work # ( ) _______________

E-Mail ____________________________

Parental Educational History (optional)

Highest level of educational achievement by mother (check one):

High School/G.E.D.________ Some College __________ B.S. or B.A. __________

M.S. or M.A. ________ Ph.D. ________ Ed.D. _________ M.D. __________

Highest level of educational achievement by father (check one):

High School/G.E.D.________ Some College __________ B.S. or B.A. __________

M.S. or M.A. ________ Ph.D. ________ Ed.D. _________ M.D. __________

How did you hear about the RISE Program? a) letter b) class visits c) web site d) word of

mouth/friend e) RISE/Bridge student f) faculty/advisors g) other, describe____________________

I hereby give permission to RISE Program personnel to access my academic records for the

purpose of evaluating this application. Signature: ______________________ Date: ___________

Please return completed application form and a copy of your college transcripts to: Claude Laird, RISE
Program Coordinator, 140 Sequoyah, 155 Indian Avenue, Lawrence, KS 66046 (Phone: 785 832 6646).