REM-SMT PROJECT at SUNY OSWEGO
2003 STUDENT PARTICIPATION FORM (Summer Institute Dates: July 14 - August 8, 2003
Social Security Number: --
Sex: Male Female
Ethnicity: White (not Hispanic Origin) Black (not Hispanic Origin) Hispanic American Indian or Alaskan Native Asian Pacific Islander
Name of Parent or Guardian: First: Middle: Last:
Name of School Attending: City: State: Zip: School Phone Number: ( ) -- Guidance Counselors Name:
Are You planning on staying on campus? YesNo
Student's E-Mail Address:
Are you planning to take the course for college credit?YesNo
We will send you a receipt to the e-mail address specified when we receive your application! Thank you