Pre-MAP Information Form

If you are interested in joining Pre-MAP, please fill out the form below and we'll contact you with more information about the program as the school year approaches. Please feel free to leave any question blank.

Name:
Email address:
Phone Number:
High School:
City, State:
Ethnic/Cultural Group with which
you identify the most (i.e. ethnicity):
Are you low income? Yes
No
Are you/will you be a first-generation
college student?		 Yes
No
Gender:
Do you know what you'd
like to major in at the UW?		 Yes
No
If yes, what is your intended major?
When do you expect to enroll at UW (ie, Fall 2009)?
Any other pertinent information:
Where did you hear about us?:
     University of Washington Department of Astronomy