Department of Chemistry
SUMMER 2001 UNDERGRADUATE RESEARCH ASSISTANTSHIPS
RESEARCH EXPERIENCES for UNDERGRADUATE PROGRAM
June 4 - August 10, 2001

APPLICATION FORM
(DEADLINE: March 1, 2001)

Name (Last,First):_____________________________________________ Soc. Sec. No.___________________________________
Undergrad. Insitution:_________________________________________ Expected Graduation Date:_______________________
Major:_________________________________________________________ Prior Research Experience (Yes or No):__________
Campus Address:________________________________________________ Campus Phone, Daytime:__________________________
_______________________________________________________________ Campus Phone, Evening:__________________________
_______________________________________________________________ E-Mail Address:_________________________________
Permanent Address:_____________________________________________ Last Date on Campus:____________________________
_______________________________________________________________ Permanent  Phone:_______________________________
_______________________________________________________________

 

PREFERRED AREAS OF RESEARCH INTEREST  (Select one.)
 
____  Analytical Chemistry  ____  Organic Chemistry 
____  Biological Chemistry  ____  Physical Chemistry
____  Inorganic Chemistry

 

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: __________________________________________ Name: __________________________________________
Title:  ________________________________________ Title:  ________________________________________
Department:  ___________________________________ Department:  ___________________________________
Institution: ___________________________________ Institution: ___________________________________
Phone:  ________________________________________ Phone:  ________________________________________
E-Mail:  _______________________________________ E-Mail:  _______________________________________
 

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

Signature: ________________________________  Date ____________

CENSUS QUESTIONS:
 
Group (check one) Personal Challenges
_____  African American Date of Birth _____ Auditory
_____  Caucasian ______________ _____ Motor
_____  Hispanic Sex _____ Visual
_____  Native American ____________ _____ Other
_____  Pacific Islander Citizenship: ___________
_____  Other (identify)  ____________________ ______________ ___________
 

ADDITIONAL MATERIALS:  (These must be submitted before an application can be reviewed.)
1) LIST OF SCIENCE AND MATH COURSES THAT YOU ARE TAKING THIS CURRENT SEMESTER/TERM.

2) STATEMENT OF ACADEMIC INTERESTS AND CAREER GOALS
This statement should be typed, double-spaced, and 1-2 pages long.  Include your intentions regarding post-baccalaureate programs (graduate school, medical school, MD-PhD program, or other).  Also include details of any previous research experience, although prior research experience is not a pre-requisite for this program.

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

4) AN OFFICIAL TRANSCRIPT
This should include Fall 2000 grades and may be enclosed or sent directly.

SUBMISSION DEADLINE: March 1, 2001
Submit to:  Questions or Problems
Prof. Joseph J. Grabowski
REU Program Directorr Contact Prof. Grabowski at:
Department of Chemistry Phone:  (412) 624-8632
University of Pittsburgh Fax:  (412) 624-8611
Pittsburgh, PA  15260 E-mail: joeg@pitt.edu

The University of Pittsburgh, as an educational institution and as an emloyer, 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:  20 December 2000