Personal Information
Educational Information
School Name & Address

If you haven't applied to Tougaloo and sent your transcripts and test scores, please email copies to

Intended Discipline to Major in College
Intended College to Attend
Please provide the names and email addresses of two referees

Reference Letters: Please arrange to email two letters of recommendation (Email:
Summer Science & Engineering Program Referral Form

Medical Information
Parent/Guardian Information
(Please type your name for Signature.) I authorize the verification of the information provided on this form.
(for minors)
In addition to submitting the application below, you must also submit your Transcript; your ACT/SAT; an Essay narrating your interest, strength, weakness, and career goals (Maximum 400 words); and two letters of recommendation. These documents must be e-mailed to in order to complete your application. For questions, please contact: Dr. M. Watkins 601-977-7794.
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