Print this form and fill in the blanks. (This form cannot be submitted electronically. A complete application includes parts B through F.)
Name (Last name, First name ) Male Female Address City State Zipcode
Telephone number
Date of birth Social Security Number Name(s) of Parents or Guardians Name of your school Address of your school City State Zipcode Name of your sponsoring teacher Name of your school principal What school grade will you complete by June 2002? In what mathematics course(s) are you now enrolled?
Include information on an attached sheet about any mathematics scores on ACT and/or SAT, performance in science fairs, MATHCOUNTS and/or the Michigan Mathematics Prize Competition, and other evidence of unusual mathematical talent and interest in the theoretical and playful aspects of the mathematical sciences.