MEP application

* Required fields

General Information
*Last Name:	*First Name:
Middle Initial:	Student (EMPL) Id:
*Initially Enrolled As:	*Current Status on Campus:
*Birthdate: YYYY-MM-DD	*Gender:

Current Contact Information
*Address:	*City:
*State:	*Zip:
*Phone: xxx-xxx-xxxx

Permanent Contact Information Use Current Contact Information
*Address:	*City:
*State:	*Zip:
*Phone: xxx-xxx-xxxx

Email
Cal Poly Email (If you have one):	Alternate Email:

Ethnicity & Citizenship
*Ethnicity:	Other Ethnicity (If "Other" selected):
*Citizenship:

If you are a Freshman Student...
Year of High School Graduation:	High School GPA:
High School Name:
High School City:	High School State:
SAT Verbal:	SAT Math:
Years of High School English:
Participated in pre-college MESA:	Years in MESA:
Math/Science Courses Completed (check all that apply): Completed Calculus? Completed Pre-Calculus? Completed Trigonometry? Completed Geometry? Completed Algebra 1? Completed Algebra 2? Completed Chemistry? Completed Physics?

If you are a Transfer Student...
Units Completed:	Semesters or Quarters:
College Name:	College City:
College State:	Years In College:
Transfer GPA:

All Applicants
Major:	Major (If 'Other' Chosen):
How much calculus have you taken?
Currently taking Junior level courses:	Currently taking Senior levels courses:
Father's highest education level:	Mother's highest education level:

Financing your education
My financial aid package includes (check all that apply): Pell Grant Cal Grant Student Loan College Work Study College/University Grant Parent Loan Private Scholarship (please specify) Other Source(s) (please specify)
My family helps with educational costs - Who?
Family Annual Income (ex: 30000):	How many members in your family:
Work Hours per Week:	According to Financial Aid, I am an Independent Student:

Previous Participation
Previous Programs I have Participated in (check all that apply): Upward Bounds Talent Search MESA AVID Trio Program EOP EOPS AFDC LSAMP School Lunch Program

Educational Background
My high school offered AP Chemistry:	My high school offered AP Physics:
My high school offered Calculus:	My high school was:

Family Background
I will be the first in my family to graduate from college
In my family, the following members have graduated from college (check all that apply): Father Mother Brother(s) Sister(s)
The primary language spoken in my home is:
My family includes (1 mother, 2 brothers, etc.):

Membership Committment Agreement
MEP Membership includes any of the following community service committment(s): Participate in Academic Excellence Workshops and Study Groups Volunteer for Outreach and Recruitment Activities: presentations at K-12 schools, mentor visiting students, publicize Cal Poly at College Fairs Provide volunteer tutoring to other students in my strongest subjects Freshman MEP students: enroll in ENGR 141 (2 units for Fall Qtr) Transfer MEP students: enroll in ENGR 303 (2 units for Fall Qtr) Join a pre-professional organization such as AISES, NSBE/SBES, SHPE or SWE * If resources are available to support my membership within MEP, I commit to the above obligations.

Application Agreement
* I hereby apply for admission to the Cal Poly Multicultural Engineering Program. I authorize the University to release my records to the Statewide MESA/MSP office. I understand that this data will be treated confidentially. I also grant permission for MEP to use my photograph and quotes in MEP promotional material.