ASM MATERIALS CAMP^SM

Please specify which ASM Materials Camp (location) you are applying for:

1^st Preference:

2^nd Preference:

Part 1

1. Students Name:
Preferred 1^st name for name tag:

2. Address:

(Street or P.O. Box)
City
State, Zip
Country

3. Email Address (most communication will be sent electronically, if possible):

4.Citizenship:

5. Sex:Male__ Female__
Date of Birth:

6. Fathers Name:
Address:
Tel: Day ____________________ Evening __________________
Mothers Name:

Address:
Tel: Day ___________________ Evening __________________

P

7.       Grade you will be entering in the Fall of 2006: ____ Junior____ Senior

8.       Name of high school:

School Address:

9.       Principals Name:

10.    Current school years grades on the following subjects (provide grades on most recent grading period):

z         Science:

z         Chemistry:

z         Physics:

z         Mathematics:

Part 2

A.       Attach a personal statement (100 words or more) why you want to be selected to participate in MATERIALS CAMP. Please include your planned college major (if known)/career plans.

B.       Attach a maximum of two (2) letters of recommendation.

C.      Are you related to an ASM member?Yes_____ No _____

If yes, please provide name of ASM member and your relationship:

Name of ASM Member
Relationship

D.      Attach a copy of most recent report card.

E.       Enclose one (1) recent photo, 2x2 or larger, for publication. (Photo will not be returned.)

RETURN ON OR BEFORE March 1 to:

Jeane Deatherage

Administrator, Foundation Programs

ASM Materials Education Foundation

9639 Kinsman Rd., Materials Park, OH44073

FAX:440/338-4634