Please type or print clearly.

Name:   

Address:        

Phone Number:________________

College currently attending:__________________________________________________

Indicate below, in chronological order, college mathematics courses taken
and those in progress.
                                        Quarter/Year or
        Course  College Instructor      Semester/Year   Grade
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        


List any math related experiences  (courses, internships, workshops,
tutoring, reading, club, etc.).

                Instructor or
        Item    Supervisor      Semester/Year
        
                
        
        
        
        
        
        
Why are you studying mathematics?  What do you plan to do after graduation
from HSU?





















I certify that I am eligible for the Harry S. Kieval Mathematics
Scholarship for transferring students.


                        
                Signed


Please include with your application one or two letters of recommendation
from mathematics instructors commenting directly on what they believe
distinguishes you as a potential mathematics major.  Feel free to append
other information or comments you feel would be of assistance to the
committee.  Completed applications must be received by April 15, 2004.
Send materials to:

        Mathematics Department Prize Committee
        Department of Mathematics
        Humboldt State University
        Arcata, CA  95521-8299