Sfvfeq

RESEARCH APPRENTICESHIP PROGRAM

FOR HIGH SCHOOL STUDENTS (RAP)

Please key or type all answers. Hand written applications will not be accepted. Once your part of the application is

complete, print form, submit to your guidance counselor to complete, and sign in ink. Return the completed

application along with a $25 non-refundable check or money order (NO CASH) and all required attachments by

Friday, February 19, 2016 to Research Apprenticeship Program, School of Agriculture and Environmental

Sciences, C. H. Moore Agricultural Research Station, North Carolina A&T State University, 1601 E. Market St.,

Greensboro, NC 27411-1011. Checks should be payable to: N.C. A&T University Foundation. NOTE: Applicant

must be a U.S. citizen, have a minimum GPA of 2.8, and must be entering his or her junior or senior year for the

2016-2017 academic year. The application is not complete until the check has cleared. For more information,

contact Kishaa James at (336) 285-4798, kdosunmu@ncat.edu. The research apprenticeship program will be

held June 19 – July 15, 2016.

PERSONAL INFORMATION

Date of application

Name

______/ _____/ ________

_________________________________________________________________

Street address ___________________________________________________________

City ___________________________ State ____ Zip _________ Email: ______________________________

Home telephone (_____) _____-_____

Cell (_______) _____-_____

Date of birth ___ /____ /_____ Place of birth (City/State)____________________________________

U.S. citizen: s Yes

No

Ethnic Group/Race - (Used for reporting purposes only. Check one.)

American Indian or Alaskan Native

Black (Non-Hispanic Origin)

Asian or Pacific Islander

Sex:

Male

Hispanic

Caucasian

Other

Female

IN CASE OF EMERGENCY CONTACT:

(Relationship to applicant: father, mother, guardian, etc).

Address:_______________________________________________________________________

Home telephone (____)...