All new Summer Science Institute applicants will be required to submit a $25 application fee and a copy of your most recent transcript. You will receive an email upon submission of this application with further instructions.

If you have questions, please contact us at 614-236-6520 or summerinstitute@capital.edu.

Name

First (Given) Name

Middle Name

Last (Family) Name

Preferred Name/Nickname

Other Last Names Used

Contact Information

Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Mobile

Home

Biographic Information

Legal Sex

Birthdate

Primary Citizenship

Dual Citizenship

Social Security Number

*Your social security number is collected to correctly match your record in our systems and issue a 1098T tax form to students earning credit.

Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

Are you Hispanic or Latinx?

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

Marital Status

Religious Affiliation

Have you previously attended Capital University, Capital University Law School or Trinity Lutheran Seminary?

In which part(s) were you enrolled?

Capital University

Capital University Law School

Trinity Lutheran Seminary

Indicate the first and last name you used at the time of enrollment.

Approximately when did you start attending?

Approximately when did you stop attending?

Academic History

List all colleges/universities attended. If you attended a university branch, please only select the main campus from the available options.

College/University #1 (Most Recent)

College/University #1 CEEB Code

College/University #1 Start Date

College/University #1 End Date

College/University #2

College/University #2 CEEB Code

College/University #2 Start Date

College/University #2 End Date

College/University #3

College/University #3 CEEB Code

College/University #3 Start Date

College/University #3 End Date

If you attended more than 3 colleges or universities, please add their name and the years attended in the space below.

Disciplinary History

Have you been convicted or pleaded guilty to a felony within the last 7 years?

Yes

Please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.

Class Selection

Intended Term

Students using financial aid must get a consortium agreement from your home institution, get the necessary signatures and submit it to Capital’s financial aid office, where it will be completed and mailed back to your home institute. You must then provide an official notification of your summer term aid eligibility to Capital’s student accounts office prior to the first day of class, letting Capital know how much financial aid you will be receiving in Order to start classes. Failure to complete these steps may result in you being cancelled out of your class.

SESSION I COURSE SCHEDULE

Session I Courses (May 20 - June 14, 2024)	Schedule	Credit Hours*
CHEM 171/173 Chemical Principles I	MTWThF Noon - 3pm Lab MTWTh 8:30 - 11:30pm	4 semester hours
CHEM 231 Organic Chemistry I	MTWThF 9am - noon	3 semester hours
CHEM 233 Organic Chemistry I Lab	TWTh 1:30 - 5:30pm	1 semester hour
MATH 230 Calculus I	MTWThF 9am - 12:30pm	4 semester hours

Select the first session course(s) you intend to take.

CHEM 171/173 - Chemical Principles I (4)

CHEM 231 - Organic Chemistry I (3)

CHEM 233 - Organic Chemistry I Lab (1)

MATH 230 - Calculus I (4)

SESSION II COURSE SCHEDULE

Session II Courses (June 18 - July 15, 2024)	Schedule	Credit Hours*
CHEM 172/174 Chemical Principles II (General Chemistry II)	MTWThF noon - 3pm Lab MTWTh 8:30 - 11:30am	4 semester hours
CHEM 232 Organic Chemistry II	MTWThF 9am - noon	3 semester hours
CHEM 234 Organic Chemistry II Laboratory	TWTh 1:30 - 5:30pm	1 semester hour

Select the second session course(s) you intend to take.

CHEM 172/174 - Chemical Principles II (4)

CHEM 232 - Organic Chemistry II (3)

CHEM 234 - Organic Chemistry II Lab (1)

Please use the box below to indicate your questions or comments.

Statement of Financial Responsibility

I have a legally binding obligation to pay Capital University all tuition, room and board (if applicable), and other applicable fees by the due date.

This payment obligation is binding whether or not I access my electronic billing information (eBill), and whether my account is being paid by me or another person.

If my account is not paid by the due date, I understand that I may be assessed a late payment fee.

Failure to attend classes does not constitute an official drop or withdrawal. I understand that to drop or withdraw from a class, I must complete and submit all required paperwork in a timely manner. If my account becomes delinquent, I will not be allowed to register for the next semester and, if I am a graduating student, I may not be allowed to participate in Commencement and I will not be issued a transcript or diploma until the account is paid.

I understand that should my account be placed with a collection agency, that my account will be assessed a fee based on a percentage of the debt up to the maximum allowed by law and that all costs and expenses, including reasonable attorney fees that Capital University incurs for the collection of this debt will be my responsibility.

Telephone Consumer Protection Act (TCPA) - I authorize Capital University and its affiliates, agents and contractors to contact me regarding my account balance to the University, including the repayment of my balance, by any phone number I have provided and may provide in the future, including any wireless number, using automated technology (including automated telephone dialing or artificial or pre-recorded voice or text messaging).

Submission

Capital University prohibits discrimination on the on the basis of age, ancestry, color, disability, gender, gender identity or expression, genetic information, military status, national origin or ethnicity, race, religion, sex, sexual orientation, protected veteran status, or any other characteristic protected by law and admits qualified students to all the rights, privileges, programs, and activities generally accorded or made available to students at the University.

Right to Know – Consumer Information is available at: http://www.capital.edu/About-Capital/Facts-and-Figures/Consumer-Information/. Hard copy available upon request.

Annual Security and Fire Safety Report, containing crime/fire statistics and relevant university policies, may be found at: http://www.capital.edu/security-reports/. Hard copy available upon request.

The electronic signature consists simply of your name, typed by you on your keyboard. The signature is your confirmation that the application you have filled out is your own work, the information is factually true and you agree to the terms above. Once you type in your name and the date, this will count as your electronic signature.

In place of your signature, please type your full legal name:

Summer Science Institute Application

SESSION I COURSE SCHEDULE

SESSION II COURSE SCHEDULE