College or University:

Major:

Class: Fresh Soph Jr Sr

Graduation date: Month and Year

Degree:

Have you had any previous research experience? (e.g. Internship/Co-Op)

Mailing Address:

Telephone (Home):

Telephone (Other):

 E-mail:

Please check applicable items: Male Female U.S. Citizen U.S. Permanent Resident

Ethnicity Disability (for our records only)

Prioritize projects of interest by mentor:

First Choice:

Second Choice:

Third Choice:

To include your resume and statement of goals, please copy and paste them into the text boxes below.

Resume:

Statement of Goals:

Or, you may send an e-mail to Earl Adams with your resume and statement of goals as attachments.

Required application materials

1. Application form
2. Resume
3. Statement of goals (500 words or less on how this program will contribute to your goals)
4. Transcript
5. Two reference letters

Two reference letters and an official transcript can be mailed separately, however they should be postmarked no later than the deadline, March 1^st 2009. If reference letters are included in the application, they should be sealed in envelopes with the signature of the recommender across the seal.

Special housing needs
Will you be bringing a family member(s) or do you have a special housing need?

Yes No

Will you need daycare? Yes No

Please explain or list the name(s) and relationship(s) of your family member(s):

References

Name:

Address:

Phone:

E-mail:

Name:

Address:

Phone:

E-mail:

Click on Submit to send your information to us.

You will receive a confirmation email within the next two business days. If you do not receive confirmation that we have we received your application, you will need to apply via e-mail to Dr. Palmer or by postal service. This form will not work with web email accounts such as Yahoo, Hotmail, or AOL.