* Indicates required field

Your Name: *

Permanent Address: *

Your Email: *

Home Phone: *

Cell Phone:

All College(s) attended: *

Composite GPA (Grade Average): *

Park University Scholarships Earned:

College Extra-Curricular Activities:

Personal and Professional Goals:

Please explain in 300 words or less why you want to become a part of the Honors at Park University Program:

Are you a member of PTK?: Yes

If you are not a member of PTK, please request that a faculty member who can assess your potential to work independently to design and complete a research project send a letter of reference to the Program Director at virginia.brackett@park.edu.

Faculty Member's Name:

Faculty Email address:

For further information, please contact:
Virginia Brackett, Ph.D., Director, Honors Program
Park University
8700 N.W. River Park Dr.
Parkville, MO 64152-3795
or e-mail virginia.brackett@park.edu