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Full Name:
Male: Female:
Street Address (City, State, Zip Code):
Phone:
Cell Phone:
Email:
Are you a U.S. Citizen? or Permanent Resident?
Social Security Number:
Date of Birth:
Mother's Name:
Mother's Occupation:
Father's Name:
Father's Occupation:
Country of origin (optional):
Language(s) spoken (optional):
Step 1 of 3
High School:
High School Address:
High School Telephone:
High School Average:
Mathematics Average:
Please list any high school special honors or awards you have received and any extracurricular activities involving mathematics:
Current Mathematics Course:
Date of High School Graduation:
Have you filed a Queens College Scholarship Application? YESNo
Have you filed the FAFSA? YESNo
SAT Scores
Date :
Verbal :

Math :
Writing :
Regents Grades:
Geometry :
Algebra :

Trigonometry :
English :
How did you learn about the TIME 2000 Program

Teacher Chair College Advisor

Ad QC Open House QC Website

TIME 2000 Conference at Qc TIME 2000 Student

TIME 2000 Website TIME 2000 Letter

Other

List any math tutoring experiences you have had:
Have you filed a City University Freshman Application listing Queens College as your first choice? YESNo
If not, contact Admissions for information about application procedures at 718-997-5600. TIME 2000 will only process your application after you have been accepted to Queens College
Step 2 of 3

In a well-constructed essay of approximately 500 words, tell the TIME 2000 staff about yourself, your interest in and commitment to the teaching of mathematics, and any information not included elsewhere that you wish the staff to consider when reviewing your application (e. g., special skills and talents, physical challenges, prior schooling in other countries, etc.). Please print or type your essay on a separate sheet. Make sure to include your name, signature, and date on the essay.

Step 3 of 3