Students Name: ____________________________________

Name of High School: _______________________________

Mailing Address: ___________________________________
_______________________________________________

Telephone Number: _________________________________

Year in High School: ________________________________

Anticipated Graduation Date: __________________________

Social Security Number: ______________________________

Grade Point Average: ________________________________

Ethnicity: _____ African American _____ American Indian or Alaskan _____ Asian American _____ Hispanic _____ Caucasian ____ Muliracial

Name of Recommender (print): __________________________________

Signature of Recommender: ____________________________________

Name of Parental Guardian (print): _______________________________

Signature of Parental Guardian: _________________________________

In addition, please provide a Letter of Recommendation from a teacher.

Return Applications and send inquiries to:
Dr. Melanie Page
Oklahoma State University
Department of Psychology
215 North Murray
Stillwater, OK 74078
(405)744-7334
email: melanis@okstate.edu