NanoSURE at UNC Charlotte NSF Research Experiences for Undergraduates 2009 Application Form
I. Personal Data
Last Name:
First Name:
Middle Name:
Street 1:
Street 2:
City:
State: – State – Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zipcode:
Phone #:
Primary Email:
Confirm Primary Email:
Other Email:
II. Education and Educational Goals
Anticipated Degree: Major: Overall GPA: GPA in major:
Date entered college: – Month – Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec – Year – 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 Total hours earned: Expected Graduation Date: – Month – Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec – Year – 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960
Academic Awards / Honors:
Extracurricular Activities:
If yes, please describe:
List three fields of interest in which you would like to pursue graduate studies, if applicable:
1. 2. 3.
III. Other Information
Please indicate your research interests in the order of preference with 1 being your first choice and 3 being your last:
IV. Parent / Guardian Information
Parent / Guardian Name:
City: State: – State – Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Email:
Zipcode: Phone #:
V. Personal Statement
Please attach a one page essay describing your academic and career goals and your interests in nanoscale science research. Please include why you want to participate in this program and why you selected the research interests above.
VI. References
Two recommendation letters are required. At least one should be from a science teacher / professor. The recommender should send their letter to the address shown below.
Download Recommendation Form
Recommender's Name: Position: Department: Phone or Email:
VII. Transcript
Please include a copy of your unofficial transcript with your application.
VIII. Submit Application