Middle Tennessee State University-UB-Summer Application

Summer Academy Application

***Application Deadline: April 24, 2026***
I. Student Name:

First NameMiddle NameLast Name
Gender:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Phone:
(999)999-9999
Student Personal Email Address:
example@example.com
Parent/Guardian Name:

First NameLast Name
Parent/Guardian phone:
(999)999-9999
Parent/Guardian email address
example@example.com
II. School:
If other, list school.
Grade:
G.P.A.
Have you taken the ACT?
If yes, what’s your composite score
III. Career Aspiration: List your career aspiration
Are you employed?
If yes, where are you employed?
IV. Have you participated in previous UB summer academies?
V. What colleges are you interested in visiting?
VI. Are there any cultural events/activities/workshops that you are interested in doing?
VII. Choose a roommate. You may request a roommate, and your roommate request must also choose you as a roommate.

(Student requests may or may not be honored. Your request must list you as their 1st choice and you must be listed as their 1st choice.)
Request No #1

First NameLast Name
Request No #2

First NameLast Name
Student Signature:
Date:

MonthDayYear
mm-dd-yyyy
Parent Signature:
Date:

MonthDayYear
mm-dd-yyyy

Summer Academy Application