CSTEP Application Collegiate Science and Technology Entry Program (CSTEP) Application Name First Last U NumberDate of BirthPermanent Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Temporary Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code (if you are living off campus but not at home)SUNY Poly Email Cell Phone NumberResidence Hall name (on campus) if applicableParent and/or Guardian Name(s)Parent and/or Guardian Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you a United States Citizen? Yes No Are you a resident of New York State? Yes No Ethnicity (for NY reporting purposes only) Black/African American Native American/Alaskan Native Hispanic/Latino White/Caucasian Asian* Pacific Islander* *denotes must meet financial eligibility requirementsLegal Sex Male Female Gender Male Female Nonbinary Add another gender Pronouns He/Him She/Her They/Them Add another pronoun set Are you a first generation college student? Yes No (Definition of a first generation college student is,) - Parents and/or legal guardians DID NOT complete a Bachelor's degree.Year you first matriculated into collegeAre you a college transfer student? Yes No If yes, were you a CSTEP student at your previous institution? Yes No What was the name of the school you most currently transferred from, and what was your major?Are you now, or were you ever enrolled in an EOP program? Yes No Were you enrolled in a STEP program in high school? Yes No Academic InformationWhat is your current academic status with us here at SUNY Polytechnic Institute Freshman Sophomore Junior Senior Graduate Level (Masters) Anticipated year of graduationCurrent GPA (if applicable)Major/field of studyWill you be pursuing an advanced degree, (master’s program and or PhD) Yes No Have you ever conducted academic research? If so, please provide a brief description.What is your intended career choice?Agreement * Required I agree to the terms and conditions stated I agree to fully participate in activities sponsored by the CSTEP program at SUNY Polytechnic Institute. By signing this application, I hereby give consent to the use of any form of media, photo or video of myself for promotional purposes of the CSTEP program.
