Tennessee GEOPATHS

Date:

Name:

Schools: UT      Roane State      Pellissippi State      Volunteer State

Phone: (i.e. 123-456-7890)

Email:

How did you hear about this program? [Check all that apply]

Poster
Email
Faculty member spoke with me
Brochure

Class presentation
Website
Friend
Other:

Are you enrolled in or do you plan to transfer to a four-year college or university?

Yes       No       Not Sure

If Yes, projected start date:

Select One:

Applying/planning to apply to: (separate schools with a comma)


Attending or Accepted at: (separate schools with a comma)

Are you planning to register as a major in geoscience?

Yes      No      Not Sure

Are you planning to register as a minor in geoscience?

Yes      No      Not Sure

Did either of your parents complete a bachelor’s degree? Yes     No

Are you of Hispanic or Latino origin or descent?

Yes, Hispanic or Latino
No, not Hispanic or Latino

Which category best describes your race? [Mark one or more]

White
Black or African American
Asian
Native Hawaiian or Other Paciific Islander
American Indian
Other

What is your gender?

Male
Female
Other:

What is your hometown and state?

What is your age?

Leave this empty: