CSEMS Scholars Program Application Form
I.  General Information
Name:                                                                                                
Address:                                                                                                 
                                                                                               
Phone:                                                
Email:                                                
Intended major:                                                High School GPA:                    
ACT composite score:                                       Class rank:                       
II.  References

List the names, addresses and phone numbers of three references who have agreed to comment on your motivation and academic ability.  At least one should be an academic reference, for example a teacher or tutor, and at least one should be a personal reference, a person who knows you well.

Reference #1 (Academic Reference):
Name:                                                                                                
Address:                                                                                                
                                                                                               
Phone:                                                 
Reference #2 (Personal Reference):
Name:                                                                                                
Address:                                                                                                
                                                                                               
Phone:                                                
Reference #3:
Name:                                                                                                
Address:                                                                                                
                                                                                               
Phone:                                                
III.  Essay
Attach an essay, no longer than 1000 words, in which you describe your career goals and how involvement in a CAMP project will help you achieve them.  You may wish to discuss any experiences that motivated your interest in this profession, what you know about the profession, what you hope to do as a member of the profession, why you believe this is right for you, what you have done to prepare yourself to begin study in this area, etc.  
Send to: CSEMS Scholars Program
Academic and Enrollment Services
South Dakota School of Mines and Technology
501 East Saint Joseph Street
Rapid City, SD  57701-3995