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Application

Interested applicants are strongly encouraged to review the eligibility requriements before filling out or submitting any application materials. To apply:

  1. Download the Application AND Download the Student Contract
  2. OR fill out the form below and click "Submit Form"
Note: If you decide to fill out the online applicaiton, also be sure to downlad the student contract.

Note: All paper applications (option 1) and contracts (both options) should be returned to Ms. Reiter.

First Name:
Last Name:
Date:
Student ID:
Gender: Male
Female
Date Of Birth (mm/dd/yyyy):
Ethnicity:
Current Address
Street:
City:
State:
Zip:
Phone (###-###-####):
Email Address:
Permanant Address:
Street:
City:
State:
Zip:
Parent/Guardian's Name:
Best method to contact me is: Phone
Voice Mail
E-mail
Best time to contact me:
Classification: Freshman
Sophomore
Junior
Senior
Expected Graduation Year:
Major(s):
Minor(s):
The most important services / information that I wish to receive from NUCLEUS are: (Check all that apply) Time Management
Familiarity with Campus Resources
Tutoring
Advisement
Academic Support
Career Planning
Graduate School Planning
Internship / Summer Program Placements
Faculty Networking Skills
Other*:
Briefly describe your career goals:
Briefly describe your leadership activities:
Briefly describe your extracurricular activities: