2023 PSSI Application Form

2023 LRSM UPenn PSSI Application

July 10 – August 3, 2023 (Monday - Thursday, no Friday sessions)
Note: Penn requires all accepted applicants have health insurance so should you be accepted, we will require proof before the program begins.
Are you within daily commuting distance of the University of Pennsylvania campus? It is recommended that participants' daily commute does not exceed 1 hour.*

YesNo
Can you provide proof of full COVID vaccination if selected and offered a spot in this year's cohort? Proof will be required before the start of the program.

YesNo
The following items will be required in order to submit an application. Note: applications that do not have the required documents and letters by the deadline will be considered incomplete.
1. Personal Data:

Tell us about yourself
Full Name*

First NameLast Name
School E-mail :*
Where the confirmation and future communications will be sent to
Personal E-mail :*
An email address that is NOT from your school
Which email address should we use to contact you about your application?

SchoolPersonal
Your Phone Number*

Area CodePhone Number
Parent/Guardian Name: *

First NameLast Name
Parent/Guardian Email: *
example@example.com
Parent/Guardian Phone Number*

Area CodePhone Number
Parent/Guardian preferred method of communication*

PhoneEmailOther
Home Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Current school (no abbreviations)*
What type of school do you go to? (note: this is just helpful for reporting)*

PublicPrivateCharter
Current school's address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Current year when applying*

FreshmanSophomoreJuniorSenior
Which of the following science courses have you taken (or are you currently taking)?*

ChemistryPhysical SciencePhysicsBiologyOther
Cumulative GPA/scale (e.g. 3.2)*
Maximum GPA possible at your school (e.g. 5.0 if weighted, etc.)*
What is your current age?*
How did you hear about this program?*

Previous program participantPeer/friendYour advisor/department/programListserv/mailingWeb search/websiteStudent group or professional societyFlyerOther
If you heard about our program through a website, please specify which one
Have you previously submitted an application for admission to our program?*

YesNo
3. Statistical Information for post program evaluation
This information is requested for post-program report generation only and in no way affects your application. All responses are optional and strictly confidential.
Current plans post-graduation

Attend community college or vocational SchoolAttend a 4-year college or universityGet a jobLearn a tradeTravelTake some time offVolunteerOther
Please indicate your gender

MaleFemaleTransgenderedPrefer not to sayOther
Please indicate how you would describe your ethnic group

African-AmericanAsianAmerican Indian or Alaska NativeCaribbean-AmericanLatino/Latina or HispanicMiddle EasternNative Hawaiian or Pacific IslanderSoutheast AsianWhitePrefer not to sayOther
Do you identify as someone with a disability?

YesNoPrefer not to sayOther
4. Short Answer
In PSSI, you will be doing challenging science work that many people do not see until college. In 1-2 paragraphs (under 400 words), describe a time when you struggled with a challenging task and how you dealt with that challenge. *

0/400
In 5 sentences or less, state briefly what your near-future goals are (university, work, etc.)*

0/300
5. Recommendation
You must arrange for two adults to submit recomendation forms on your behalf. One must be from a current or former science teacher. The second recommendation may also be a teacher (of any subject) but can also be a coach, club advisor, school administrator, or other adult who knows about your work ethic and achievements. You may not ask a family member or friend to write a recomendation for you.

You will need to send them the following link, which will be found in the confirmation page and email as well: http://www.lrsm.upenn.edu/outreach/pssi-let-of-rec-upload/
Recommender #1*

First NameLast Name
E-mail*
Relationship to you*
Recommender #2*

First NameLast Name
E-mail*
Relationship to you*
6. Additional Materials
Upload Report Card/Transcript (unofficial is acceptable)*

Upload a File
PDF or image file of your most recent transcript. Taking a picture is okay, so long as we can read it. Cancelof
We recommend you submit your transcript digitally with the above uploader, but if needed you may send it to the following address (also found on the general PSSI page):

Mark Licurse
Director of Education & Outreach
LRSM, University of Pennsylvania
3231 Walnut Street Philadelphia, PA 19104-6202
Resume/CV*

Upload a File

Cancelof
If you have any special needs, concerns, or comments, please use this space to explain them
6. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received.
E-Signature:*
Should be Empty:

2023 LRSM UPenn PSSI Application

1. Personal Data:

3. Statistical Information for post program evaluation

4. Short Answer

5. Recommendation

6. Additional Materials

6. Applicant's E-Signature