USC Discovery Scholars

INSTRUCTIONS: Please complete this form to indicate your intention to become a Discovery Scholar. Fields in red are required.

This form must be completed by Tuesday, January 22, 2008. Please note that it is not necessary to submit materials at the time the form is completed.

You will receive a confirmation of receipt of this form by email within a few days.

Note: In order to apply, you must be currently enrolled in an undergraduate program with expected graduation in either December 2007 or May 2008.

Your Personal Information

First Name:	Middle Initial:			Last Name:
10 digit USC ID: What is this?
Expected Graduation Date:
Email Address:
Local Address
Local Street Address:
City:		State:	Zip:
Local Phone Number: ( (123) 456-7890 )
Permanent Address
Permanent Street Address:
City:		State:	Zip:
Permanent Phone Number: ( (123) 456-7890 )

Discovery Scholar Requirements
You will receive instructions for submitting materials that meet the certification criteria of your school. Your materials will be certified by a faculty panel. In addition to receiving the certification, you must graduate within 5 years at USC and you must have no less than a 3.5 overall grade point average.

Please see below for school specific criteria regarding eligibility to the Discovery Scholars Program:

Type of Submission (i.e., portfolio, thesis, first-author publication etc):

Working Title of Submission:

Home Academic Unit of Student Submission:

Your Academic Information
Note: You must officially declare your major to be considered for certification.

First Major
Second Major
Third Major
First Minor
Second Minor
Third Minor

USC Undergraduate Programs, 2004