Online application for the 2004 REU Program at UGA

               Last                   First         MI
Name     

College/University 

Major / Minor         

Fall 2004 Status  Fr    So    Jr    Sr

US Citizen/Perm Resident?  Yes   No

Expected Graduation Date 

Cumulative GPA  on a scale of 

GPA for Science & Math  (estimate, on same scale)

Social Security Number 

Date of birth 

Science/Math Course Grades (one per line.  E.g. "Physics 1: A"): 

Emails:                       
Home:  School: 

Telephone Numbers 
Home:  School: 

FAX                            

Web Page URL          

Mailing address on March 15, 2004

  Street address   
  Address (cont.) 
  City                    
  State/Province  
  Zip/Postal code 
  Country              

Home/Permanent Address

Street address   
Address (cont.) 
City                    
State/Province  
Zip/Postal code 
Country              

If you would like to work in a specific area or with a specific mentor, please enter that information here:

Computer OS's, languages, & packages. Please check all that you have a working knowledge of:

Windows/Dos	IRAF	Excel	SM	FORTRAN
Unix/X-Windows	IDL	Mathematica	Mongo	C
Macintosh	AIPS	MATLAB	HTML	C++
TeX/LaTeX	GIPSY	Labview	Java	BASIC

Other:

Scientific and related employment since High School, including assistantships:

Honors and Awards:

Other Relevant Experience:

Hobbies, Sports, Interests, etc.

Personal Essay. Please write a one-page (approx. 250-750 words) essay about your background, interest in physics and/or astronomy, and why you think you would be a good candidate for this program. Edit on your home computer, then cut-and-paste into this window (i.e., don't send us a first draft!):

Arrange to have two faculty members complete letters of reference. If possible, we ask that letters of reference be submitted via email to Dr. Loris Magnani, UGA REU Program Director, at the address reu@hal.physast.uga.edu.

Again, all materials must be received by 9 p.m. EST 15 March 2004

Reference #1:

Name                 
Title                   
Street address   
Address (cont.) 
City                    
State/Province  
Zip/Postal code 
Phone                 
Email                  
Years Known      
Relationship       

Reference #2:

Name                 
Title                   
Street address   
Address (cont.) 
City                    
State/Province  
Zip/Postal code 
Phone                
Email                 
Years Known     
Relationship      

How did you first learn about the UGA REU internship program?

Faculty/Advisor	UGA Website	NSF Website
REU Poster	Friend
Other (please specify):

If you have any special instructions or comments, please enter them here.

The following information is confidential. It will be seen only by the UGA-REU Program Director Dr. Loris A. Magnani, and will only be used for reporting statistics to the National Science Foundation. This section of the application form is based on NSF Form 1225.

                    Gender  Male    Female

Which one of these categories best describes your ethnic/racial status? (If more than one category applies, use the category that most closely reflects the person's recognition in the community.)

American Indian or Alaskan Native

Black, not of Hispanic Origin

Pacific Islander

Asian

Hispanic

White, not of Hispanic Origin

Do you have a disability which limits a major life activity?

Yes No

If yes, please explain briefly

Are you a veteran of the U.S. military?

Yes No

Check here if you do not wish to provide some or all of the above information.