SUMMER UNDERGRADUATE RESEARCH EXPERIENCE PROGRAM

Eligibility: Internships are offered on a competitive basis to United States citizens or U. S. Legal Permanent Residents who will be sophomores, juniors or seniors (as of Fall semester/quarter 2002) enrolled at a college or university. The CPIMA SURE program is a research-intensive program aimed at students who are interested in graduate school in engineering and/or physical sciences.

Dates of Program: The start date for the SURE 2002 Program is June 3, 2002. However, later start dates are available upon request. The Program will run for 10 weeks.

Instructions for Applying to the CPIMA SURE Program:

1. Official Transcript. Request an official transcript from your undergraduate institution to be sent directly to the CPIMA Assistant Director for Education (see address below).
2. Three Letters of Reference. Request three letters of reference to be sent directly to the CPIMA Assistant Director for Education (see address below). Print recommendation forms here. At least one letter must come from a faculty member who can evaluate your laboratory skills. Deadline for letters is February 8, 2002.
3. Application. Complete parts 1-23 of the online application below. Applications must be submitted on or before February 8, 2002 to be considered in the selection process.
   
   

APPLICATION, Summer 2002

Summer Undergraduate Research Experiences (SURE) Program

Center on Polymer Interfaces and Macromolecular Assemblies (CPIMA)

A Stanford University, UC Davis, IBM Almaden Partnership

1. Full Name (first, last)
2. Social Security Number
3. I am a	US Citizen US Legal Permanent Resident Other (may be ineligible)
4. Email Address
5. Current Mailing Address at School
5. City
5. State
5. Zip Code
5. Phone Number
6. Permanent/Home Address
6. City
6. State
6. Zip Code
6. Phone Number
6. Alternate Email Address
Questions 7, 8, and 9 are Optional.	(The following information is used by the NSF for statistical purposes only)
7. I am	Decline to specify Male Female
8. Ethnicity
9. Physical Challenges or Special Needs, etc.
10. Have you previously applied to the CPIMA SURE program?	no yes year:
11. Undergraduate Institution You Currently Attend
12. Major(s)
13. GPA (two decimal places)
14. Expected Graduation Date	Fall 2002 Spring 2003 Summer 2003 Fall 2003 Spring 2004 Summer 2004 Fall 2004 Spring 2005 Summer 2005 Fall 2005 Spring 2006 Summer 2006
15. Awards and Honors Please list any awards or honors you have received in this box.
16. What are the dates for Spring Break at your school?
17. Relevant Course Work. Please list all college level science, engineering, and math courses you have taken or are planning to complete before June 30, 2002 along with the corresponding grade you received.
18. Work Experience Describe your previous work experience (including any research experience other than laboratory coursework).
19. Plans Briefly explain how an internship with CPIMA would influence your plans following graduation and your professional goals.
20. Please refer to the project descriptions and list the names of your top three choices of senior investigators you are interested in working with along with the project number.
1st choice:
2nd choice:
3rd choice:
21. List three references who can provide information about your academic standing and your interest in science. At least one reference should be able to comment on your laboratory skills. Please arrange to have these references send letters of recommendation to the address below by February 8, 2002.
A. Name & Title
A. Company/Institution
A. Address
A. City
A. State
A. Zip Code
A. Phone
A. Email
B. Name & Title
B. Company/Institution
B. Address
A. City
A. State
A. Zip Code
B. Phone
B. Email
C. Name & Title
C. Company/Institution
C. Address
A. City
A. State
A. Zip Code
C. Phone
C. Email
22. I hereby certify that all information provided on this application is true and complete to the best of my knowledge. If accepted, I understand that providing false information is grounds for dismissal from the CPIMA SURE program. (The following is your electronic "signature" and is considered binding.)
Initials
Date
Full Name
23. CPIMA has my permission to copy all parts of my application (application, letters of reference, transcripts) for internal distribution to membersaffiliated with CPIMA during the SURE selection process.
I agree	I do not agree
24. How did you hear about the SURE Program?	CPIMA Website REU Website Former SURE student Professor (Who?) Printed flyer E-mail Journal Advertisement Other (What?) Please use this space for clarifications.
Please send official transcripts and letters of reference to the following address: CPIMA SURE Program, Summer 2002 Dr. Marni Goldman Department of Chemical Engineering 381 North-South Mall Stanford University Stanford, CA 94305-5025 marni@chemeng.stanford.edu *** Application Deadline is Friday, February 8, 2002 ***

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