I am applying for the:         ______ MASS Program
                               ______ PMASS Program
                               ______ REU Program


NAME:__________________________________________________________________________________________________
         (Last)                              (First)                             (MI)

SSN:__________________________________________      E-mail:____________________________________________


Current Address:                                    Permanent Address:

______________________________________________      ___________________________________________________
(Street)                                            (Street)

______________________________________________      ___________________________________________________
(City)                                              (City)

______________________________________________      ___________________________________________________
(State/ZIP Code)                                    (State/ZIP Code)

______________________________________________      ___________________________________________________
(Current Phone Number)                              (Permanent Phone Number)

Date and Place of Birth:____________________________________________________

Sex:    M      F                            Are you a resident of Pennsylvania:  Y N

Your Citizenship Status(check one):         ______ United States citizen
                                            ______ Permanent resident of U.S.
                                            ______ Nonresident alien, visa type_______

High School Attended and Graduation Date:____________________________________________________

_____________________________________________________________________________________________
 
College(s) Attended and Expected Date of Graduation:_________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________
 
List all Math Courses taken and in progress on an attached form.

(optional) Courses in Physics, Mechanics, Astronomy, Statistics, Computer
Science etc.: 

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

List at least two faculty members who can provide a reference for you:
  
_____________________________________________________________________________________________

_____________________________________________________________________________________________

(optional) Extra-curricular math activities (Putnam competitions, olympiad, etc.):

_____________________________________________________________________________________________

_____________________________________________________________________________________________

(optional) Participation in REUs and other summer programs:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

(optional) In what areas of mathematics are you interested?  Have you studied any areas on your own? 

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

How did you learn about the MASS Program/the REU program?

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Please write a short essay on a separate page describing your interest in math.

If you are a Penn State Schreyer Honors College student and are applying for the MASS  program, please check which courses 
you are applying to enroll in:

___ Full Program,

___ MATH 497A, ___ MATH 497B,___ MATH 497C,___ MATH 497D, ___ MATH 497E



_____________________________________________________________________________________________
(Signature of Applicant)                                          (Date)

After filling out this form, please mail it to:

MASS/Summer REU Selection Committee
111 McAllister Building
Department of Mathematics
The Pennsylvania State University
University Park, PA 16802-6401

If you have any questions or need further assistance, contact MASS Program at the above address or by e-mail at: mass@math.psu.edu

Admission:Transfer Location:University Park Major:Mathematics Code:MTHBS