NSEC REU Application

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Name

Gender

Birthdate

Local Address

Permanent Address

Email address

Fax number

Ethnicity:
African American
Asian American/Pacific Islander
Hispanic
Latino
Native American
White (non-Hispanic)
       Other (Specify):

Current Institution

City of Institution

State of Institution

Major

Department

Cumulative GPA (4 point scale)

Major GPA (4 point scale)

Current participation: MARC McNair Howard Hughes COR program

Year in School

Expected Date of Graduation

Planned Graduate Study: Master's  Ph.D.  M.D.  M.D./Ph.D. (Dual Degree)

Discipline

Statement of Research Interest:

Personal Statement: