Department of Chemistry

SUMMER 2006 UNDERGRADUATE RESEARCH ASSISTANTSHIPS

 RESEARCH EXPERIENCE for UNDERGRADUATES program

May 30 - August 4, 2006

APPLICATION FORM
(DEADLINE FOR RECEIPT OF APPLICATION: March 1, 2006)

Last Name:             First Name:              
Undergrad. Insitution: Expected Graduation Date:(mm/yyyy)
Major:                 Prior Research Experience:  (If yes, explain in "Statement of Academic Interest and Career Goals" below.)
Campus Address:        Last Date on Campus:      (mm/dd/yyyy)
Campus Phone, Daytime: Campus Phone, Evening:   
E-Mail Address:        Permanent Phone:         
Permanent Address:      
             City:      
            State:      
              Zip:      


LIST OF ALL COURSES THAT YOU ARE TAKING THIS CURRENT SEMESTER/TERM:


STATEMENT OF ACADEMIC INTERESTS AND CAREER GOALS:
Select file to upload to server:


PREFERRED AREAS OF RESEARCH INTEREST  (Select only one.):    

REFERENCES:  (Use the reference forms to request letters from two faculty members who best know your academic and research work. List these individuals here as well.)
 
Name:       
Title:      
Department: 
Institution:
Phone:      
E-Mail:     		 Name:       
Title:      
Department: 
Institution:
Phone:      
E-Mail:     

I herby certify that all of the above information is correct and true.

I hereby grant the NSF-REU program permission to use the above information for statistical analysis purposes only, with the proviso that no personal information will be released to anyone besides those few, qualified researchers doing the statistical analysis and that these researchers will only report/publish aggregate statistics.  Your willingness to participate in this statistical survey may help ensure the continued growth and vitality of this Federally sponsored program.


CENSUS QUESTIONS (note some, but not all, of these are optional):
 
Ethnicity:     

Race:          

Challenges:

Personal (Mandatory Information):
   Date of Birth: (mm/dd/yyyy)
   Sex:            
   Citizenship:  
   Have a Green Card (non-USA citizens, only)?

SUGGESTIONS FOR THE WEBSITE: Use the space below to notify us of special information or technical problems with this web site.


ADDITIONAL MATERIALS:  (These must be submitted before an application can be reviewed.)

1) TWO LETTERS OF REFERENCE FROM ACADEMIC FACULTY.
To be sent from the two persons named above directly to the Program Director (forms are available here).

2) AN OFFICIAL TRANSCRIPT.
This should include Fall 2005 grades and may be enclosed or sent directly.

RECEIPT  DEADLINE: March 1, 2006

Submit Letters & Transcript to:  Questions or Problems
Prof. Joseph J. Grabowski
REU Program DirectorContact Prof. Grabowski at:
Department of ChemistryPhone:  (412) 624-8632
University of Pittsburgh Fax:  (412) 624-8611
Pittsburgh, PA  15260E-mail:joeg@pitt.edu

The University of Pittsburgh, as an educational institution and as an employer, values equality of opportunity, human dignity, and racial/ethnic and cultural diversity. Accordingly, the University prohibits and will not engage in discrimination or harassment on the basis of race, color, religion, national origin, ancestry, sex, age, marital status, familial status, sexual orientation, disability, or status as a disabled veteran or a veteran of the Vietnam era.  Further, the University will continue to take affirmative steps to support and advance these values consistent with the University's mission.  This policy applies to admissions, employment, access to and treatment in University programs.  This is a commitment made by the University and is in accordance with federal, state, and/or local laws and regulations.

last updated:  02/03/2006

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