1. Preliminary Application for Project SEED
Please complete and Return by March 30, 2013
Project SEED is a program sponsored by the American Chemical Society (ACS) that provides high school students
with summer research experiences in chemical laboratories. The program is focused on students who are
economically disadvantaged. Students are selected based on family income, number of members in the family,
history of college attendance in the family, and interest and performance in science courses.
Please provide the following information. This will be kept confidential and will be used exclusively in the
selection process. If chosen on the basis of this form, you will be interviewed for participation.
Student Information (All fields MUST be completed)
Name __________________________________________________________________
Address ________________________________________________________________
City ___________________ State _____ Zip ___________
Phone: ___________________________ e-mail ______________________________
Birth Date ________________________
Grade entering in Fall 2013:  10th  11th  12th
List Chemistry Course(s) taken: _____________________________________________
GPA in Chemistry Courses __________
Parent/Guardian Information
Name __________________________________________________________________
Address ________________________________________________________________
City ___________________ State _____ Zip ___________
Phone: ___________________________
Total Family Income (year 2012) $______________ Family size including you ________
Proof of income (2012 tax return) will be required if you are invited to participate.
Student’s High School Information
High School _____________________________________________________________
Chemistry Teacher ___________________________
Recommending Teacher’s Contact Information:_______________________________________________
______________________________________________________________________________________
In the space below and/or on the reverse, briefly describe why you would like to participate in Project SEED.
Return to pbays@saintmarys.edu, or
J. Philip Bays, Department of Chemistry & Physics, Saint Mary’s College, Notre Dame, IN 46556