Application-Form_AY2011-2012-UG

ACADEMIC-YEAR RESEARCH EXPERIENCE FOR
UNDERGRADUATES (AY-REU)
APPLICATION FORM
2011-2012
Deadline: July 22, 2011

NAME:______________________________________________________________________________
Last

First

Middle

CURRENT ADDRESS: _________________________________________________________________
_________________________________________________________________
TELEPHONE NUMBER: _____-_____-______
EMAIL: ______________________________________________
PERMANENT ADDRESS: ______________________________________________________________
_____________________________________________________________
PERMANENT TELEPHONE NUMBER: _____-_____-______
UC ID: ________________________________
ENGINEERING MAJOR: _______________________________________________________________
ANTICIPATED GRADUATION: _______ ______
Month

Year

CUMULATIVE GPA: __________________ on a 4.00 Basis.
Please indicate if you intend to apply to a post-baccalaureate program after your undergraduate studies.
_____MS

_____PhD

_____MD

_____________________Other

Have you had any prior research experience? _____Yes _____No
If Yes, indicate the length of time, and the area of research: _____________________________________
_____________________________________________________________________________________

NSF DIVERSITY REPORTING INFORMATION
The National Science Foundation requests such information simply to determine the diversity of students our
program is attracting. It is strictly confidential and used only in aggregate form.
Gender:

Male ___

Do you have a disability?

Female ___
__ No

___

Yes (specify) ________________________________


Race:
White ___

Black or African American ___ Native Hawaiian or Other Pacific Islander ___

Asian ___

Mixed Asian & White ___

American Indian or Alaskan Native ___

Other Mixed Races ___
No Race Reported ___

Ethnicity:
Hispanic ______

Latino ______

I do not wish to provide this information __________

REFERENCES
List names of two faculty members whom you have asked to submit a letter of recommendation on your behalf. Ask them
to discuss your qualifications and suitability for a research assignment. The letters can be directly mailed by the referee to
the address below, or must be included in a sealed and signed envelope by the applicant as part of the application process.

REFERENCE 1:

REFERENCE 2:

NAME: _______________________________

NAME: ________________________________

ADDRESS: ____________________________

ADDRESS: _____________________________

____________________________

_____________________________

TELEPHONE NUMBER: _____-_____-_____

TELEPHONE NUMBER: _____-_____-______

EMAIL: _______________________________

EMAIL: _______________________________

Please list five research projects, in order of preference, on which you would like to work. Descriptions of the
available research projects may be viewed at the web page for the NSF REU Program.
Project

Project Advisor

1. _____________________________________________

____________________

Date of Meeting with
Project Advisor
______________________

2. _____________________________________________

____________________

______________________

3. _____________________________________________

____________________

______________________

4. _____________________________________________

____________________

______________________

5. _____________________________________________

____________________

______________________

I ATTEST THAT ALL INFORMATION SUBMITTED ON THIS APPLICATION IS ACCURATE.
___________________________________________________________
SIGNATURE OF APPLICANT

_____________________________

DATE

Please enclose the following:
(i) An essay of 500 words presenting your background, discussing your academic achievement, scholarships,
work experience (if any), and biographical information, explaining why you are interested in this program
and what you hope to gain from this experience.
(ii) Official transcripts.
MAIL TO:
Ms. Marlo Thigpen
STEM Program Coordinator
College of Engineering
Room 665 Baldwin Hall
P. O. Box 210018-0072
Cincinnati OH 45221
Phone: (513) 556-4864
E-mail: