Department of Chemistry
SUMMER
2003
UNDERGRADUATE RESEARCH ASSISTANTSHIPS
RESEARCH
EXPERIENCE for
UNDERGRADUATES program
June
2 - August 8, 2003
APPLICATION FORM
(DEADLINE:
March 1, 2003; but completed applications will be reviewed beginning 2/15/03)
| 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 ____________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.
Signature: ________________________________ Date ____________| Group (check one) | Personal | Challenges |
| _____ African American | Date of Birth | _____ Auditory |
| _____ Caucasian | ______________ | _____ Motor |
| _____ Hispanic | Sex | _____ Visual |
| _____ Native American | ____________ | _____ Other |
| _____ Pacific Islander | Citizenship: | _______________________ |
| _____ Other (identify) ____________________ | ______________ | |
| _____ I chose to skip this question. | Mandatory info. | _____ I chose to skip this question. |
1) LIST OF ALL COURSES THAT YOU ARE TAKING THIS CURRENT SEMESTER/TERM.SUBMISSION DEADLINE: March 1, 20032) 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 2002 grades and may be enclosed or sent directly.
| Submit to: | Questions or Problems |
| Prof. Joseph J. Grabowski | |
| REU Program Director | 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 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: 26 November 2002