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APPLICANT
NAME
PROGRAM
DATES
Beginning: 25 May
2008 |
Concluding:
2 August 2008
If you
can not be in full attendance during the entire time the program is
in-session, record dates missed and reason here:
Applicant
Information
NAME
Last
name:
First
name:
Middle
name:
CURRENT MAILING ADDRESS
Street
address:
City:
State:
Zip code:
Country:
NOTE: At this location until:
Record format as: day
/ month / year (e.g. 15 / September / 2008) - or - PERMANENT
CURRENT CONTACT INFORMATION
Day/cell telephone number:
Evening/other
telephone number:
Fax number:
E-mail
address:
GENDER
PERMANENT ADDRESS
(if different from current)
Street address:
City:
State:
Zip code:
Country:
CURRENT ACADEMIC AFFILIATION
Name of school currently attending:
City:
State:
Country:
ACADEMIC ADVISOR
Name:
Telephone
number:
E-mail
address:
CITIZENSHIP
___
United States
If
US citizen, record your STATE of residence: _____
___
Foreign
If
not a US citizen record your COUNTRY of citizenship: _____
CURRENT ACADEMIC LEVEL
___
Community College
(any
level)
___
College-level Freshman
(first
undergraduate year)
___
College-level Sophomore
(second
undergraduate year)
___
College-level Junior
(third
undergraduate year)
___
Non-graduating College Senior
(fourth
undergraduate year)
___
Graduating College Senior
(final
stage of undergraduate education)
Anticipated
month of your graduation:
Anticipated
year of your undergraduate graduation:
___
Graduated
(completed
undergraduate degree)
Year
graduated:
___
Other, (please specify)
ACADEMIC
MAJOR(S) / MINOR(S)
Academic major:
Second major:
Academic minor:
Second minor:
GRADE POINT AVERAGE (GPA)
Overall
college GPA:
based
on a scale of:
Freshman/Sophomores
High
School GPA:
based on a scale of:
Juniors/Seniors/Others
GPA
in Major:
based on a scale of:
Students
at schools not issuing grades, or at institutions whose system does
not fit this reporting scheme, are encouraged to offer a short descriptive
of their institutions grading scheme.
NATURAL
HISTORY SCIENCE UNIT
Select
the ONE natural history discipline that best categorizes your
research interests and background for placement in this program.
__
Anthropology
__ Botany
__ Entomology
__ Invertebrate Zoology
__ Mineral Science & Geology
__ Paleobiology
__ Vertebrate Zoology - Amphibians & Reptiles
__ Vertebrate Zoology - Birds
__ Vertebrate Zoology - Fish
__ Vertebrate Zoology - Mammals
ADVISOR / SUPERVISOR SELECTION
Record
the name of the Smithsonian advisor/supervisor
with whom you most want to work with as a participant in this internship
program.
Will
you accept a position working with someone other than the person identified
as your first choice?
If
yes, list three alternate advisors/supervisors
whose research also interests you as a topic for this program.
Second choice:
Third
choice:
Fourth
choice:
Applicant
Qualifications
CAREER
GOALS
Briefly state your career goals including education, research, and job/career
aspirations. Limit your answer to no more than four sentences.
SKILLS
List your computer, technical, equipment, laboratory, field, and language
skills and techniques. Limit your listing to no more than 15 entries.
ACADEMIC ACHIEVEMENTS
List your academic achievements, honors, and awards. Limit your listing
to no more than 10 entries.
COURSES and GRADES
Send separately a copy of your transcripts - OR - list here all courses
taken, and grades earned, that are relevant to this application.
EXPERIENCE / BACKGROUND
Record your relevant experience such as previous internships, volunteer
appointments, organization memberships, independent research experience(s),
etc.
ADDITIONAL INFORMATION
OPTIONAL: List here specific details not already addressed, relevant
to the review of your application.
References
FIRST
REFERENCE
NAME
Last
name:
First
name:
Middle
name:
MAILING ADDRESS
Street address:
City:
State:
Zip
code:
Country:
CONTACT INFORMATION
Day/cell
telephone number:
Fax
number:
E-mail
address:
PROFESSION
__
University/College Professor
__ Science Educator
__ Administration
__ Other, please specify:
RELATIONSHIP TO APPLICANT
__
Academic Advisor
__ Teacher
__ Employer
__ Personal Friend
__ Other, please specify:
SECOND REFERENCE
NAME
Last
name:
First
name:
Middle
name:
MAILING ADDRESS
Street address:
City:
State:
Zip
code:
Country:
CONTACT INFORMATION
Day/cell
telephone number:
Fax
number:
E-mail
address:
PROFESSION
__
University/College Professor
__ Science Educator
__ Administration
__ Other, please specify:
RELATIONSHIP TO APPLICANT
__
Academic Advisor
__ Teacher
__ Employer
__ Personal Friend
__ Other, please specify:
Optional
Survey Questions
1. Do
you consider yourself disabled or having an impairment?
If yes,
select one:
__ Hearing Impairment
__ Visual Impairment
__ Mobility Impairment
__ Other
You can
also define or qualify your answer here:
2. Do you
consider yourself a US ethnic minority?
If yes,
select one:
__ Alaskan Native American
__ African American
__ Asian American
__ Hispanic American
__ ative American
__ Native Hawaiian
__ Other *You can also specify your tribal affiliation or otherwise
qualify your answer here:
3. How
did you find out about this program?
Check
all that apply
__ Heard
about it from a friend
__ Heard about if from RTP alumni
__ Heard about it from a professor
__ Saw the paper recruitment poster
__ Saw the listing in SORS booklet or SORS
web posting
__ Found it on the NSF
web posting of REU sites
__ Found it on another web listing
__ Found it on a web search
4. If we can't place you in our program this year would you like us
to share your interest in a summer research program, and your contact
information, with other programs seeking interns for this summer?
ID
NUMBER
To correctly
link all documents associated with this submission, record an ID NUMBER.
Application ID must meet the following requirements:
Contain
at least one letter (upper or lower case)
Contain at least one number (0, 1, 2, 3, 4, 5, 6, 7, 8, or 9)
Contain at least one special character ($, @, %, #, +, or !)
You
must use this same ID
NUMBER on all application documents (application
form, cover
letter, letters
of recommendation) linked to this submission.
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