Summer Undergraduate Research Institute in
Experimental Mathematics (SURIEM)
Application Form

Please read carefully and complete all items. Incomplete information may delay the processing of your application. Submit your application by March 1, 2017 for full consideration. Review of the applications will begin immediately.
Applicants must be U.S. Citizens or Permanent Residents.


Personal Information

First Name:    Last Name:
 
Citizenship (select one): US Citizen   Permanent Resident
 
E-mail:    Gender:
 
Ethnicity
(optional):
Caucasian  African American  Latino  American Indian  Alaska Natives  Asian 
Other


Academic/Research

Current Institution:
Address:
Major Field of Study:
Class:
Cumulative GPA:
Math GPA:
 
List awards, honors, scholarships, etc. received
 
Describe your academic interests
 
What are your long term career plans?
 
What makes you especially qualified for this summer program?
 

Note: Two recommendations from a college/university level faculty or staff member, current resume and a copy of your transcipt are required to complete your application. An unofficial student transcipt is acceptable.

References: (please provide two references).These individuals will get an e-mail informing them of your application where they will be sent a link to complete the letter of recommendation.

Faculty/Staff Name:
Faculty/Staff Phone:
Faculty/Staff Email:
 
Faculty/Staff Name:
Faculty/Staff Phone:
Faculty/Staff E-mail:

Required: Attach transcipts.
Note: PDF Recommended format.

PLEASE KEEP FILENAMES SIMPLE (ex: resume.pdf or transcript.pdf)

Click on Choose File to locate your files. You need to include resume and transcipts.
Resume:
  Transcript:

Signature:  Date: (mm/dd/yyyy)
  By typing in my signature in the box above, you are confirming the information to be accurate and honest.