Application Form 2006
PERSONAL INFORMATION:
Name_____________________________________________________________
Address at school _________________________________________________
Permanent address _________________________________________________
Email ____________________________________________________________
Phone (school) ____________________________________________________
Phone (home) ____________________________________________________
Are you a [ ] US citizen or [ ] permanent resident (at the time of this application)?
(Note that only US citizens or permanent residents are eligible for the National Science Foundation REU program.)
PERSONAL STATEMENT:
1. Describe your motivation for participating in this program.
2. Describe your research experience and research interests (what kinds of problems do you like to work on).
3. Describe your academic and career goals.
4. How do you expect this REU experience to impact your education and career?
5. Do you currently plan to attend graduate school? (what school/major/degree)
EDUCATION BACKGROUND:
College(s) attended _______________________________________________
Major ____________________________________________________________
Class as of September 1, 2006:
[ ] sophomore [ ] junior [ ] senior
Expected graduation date _________________________________________
(Expected graduation must be later than August 2006)
GPA _____________________
GPA in major
___________________
Home Institution's highest degree granted in fields supported by NSF
(associate's degree, bachelor's degree, master's degree, doctoral
degree):______________________________
TRANSCRIPT:
Please make sure to
include a transcript. Both official and unofficial transcripts will be
accepted. Make sure to include the transcript along with the application
form.
PROGRAMMING BACKGROUND AND EXPERIENCE:
Please list courses taken, programming languages known, and any other relevant information.
REFERENCES:
Name of first faculty recommender _________________________________
Email of faculty __________________________________________________
Name of second faculty recommender ________________________________
Email of faculty __________________________________________________
(Recommendations should be mailed separately by faculty members to the address at the bottom of this page)
DEMOGRAPHIC INFORMATION*:
Gender: (choose one)
Male
Female
Ethnicity: (choose one)
Hispanic or Latino
Not Hispanic or Latino
Unknown
Race: (select one or more)
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Disability Status: (select one or more)
Hearing Impairment
Visual Impairment
Mobility/Orthopedic Impairment
Other
None
First-generation college students: (choose one)
_Yes
_No
* Submission of demographic information is voluntary.
ALL APPLICATION MATERIALS (including application form, transcripts, recommendation letters) MUST BE MAILED AND POSTMARKED BY March 10, 2006.
Post applications to:
MedIX REU Program c/o Daniela Stan Raicu, Assistant Professor
DePaul University
School of Computer Science, Telecommunications, and Information Systems (CTI)
Loop Campus, Office 471
243 S. Wabash Ave,
Chicago, IL 60604, USA
For any questions regarding the application, please email to Dr. Raicu at draicu@cs.depaul.edu or to Dr. Furst at jfurst@cs.depaul.edu.