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 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 _ Date of Meeting with Project Advisor _ _ _ _ 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: marlo.thigpen@uc.edu