SIUC REU Application

Interdisciplinary Materials Research
Research Experience for Undergraduates

In addition to submitting this form, please mail a copy of transcripts from all colleges and universities attended to:

REU Site Coordinator
Southern Illinois University E-Mail: jmlooft@chem.siu.edu
Department or Chemistry & Biochemistry
Neckers Room 222, M. C. 4409 Fax: 618 – 453-6408
1245 Lincoln Drive
Southern Illinois University
Carbondale, IL 62901-4409

For the online form:

Attention: If you are submitting your application with this on-line form, the only material you should mail is a copy of all relevant college transcripts. Please fill out the fields marked with an * as best you can. These are most important to the applications process.

Application Form

	Title:
*	First Name:
*	Last Name:
	Middle Initial:
*	E-mail Address:
*	Mailing Address:
	Mailing Address 2:
*	City:
*	State:
*	Zip Code:
*	Telephone:	(XXX) XXX-XXXX
*	Cellphone:	(XXX) XXX-XXXX
*	Permanent Home Address:
	Permanent Home Address 2:
*	City:
*	State:
*	Zip:
*	Telephone:	(XXX)XXX-XXXX
	Academics Please list all colleges and Universities attended, starting with the most recent. (NOTE: You will need to provide transcripts (photocopies or copies you download from your school’s website) from all colleges and universities attended. [Please make sure name appears on the transcripts – even if you simply print your name at the top.]
*	Current College or University:
*	City:
*	State:
*	Major:
*	Dates of Attendance:	mm/yy-mm/yy
*	Expected Graduation Date:	mm/yy
*	Current GPA:	x.xx
*	GPA in Major:	x.xx
	Other Colleges Attended:
	Summer Research Please go back to the beginning of the REU website (http://mtc.engr.siu.edu/reu) and select the “Project” link to review the list of research projects being conducted here at SIUC.
*	Summer Dates of Availability:	mm/dd/yy-mm/dd/yy
*	What topic(s) interest you most?
*	List the names of 4 SIUC faculty associated with your interests and with whom you would like to work:	1. 2. 3. 4.
	Personal Statement Provide a 1-page personal statement listing any honors, prizes or publications, and describing your previous research experience (if any), your plans after graduation and any additional information about yourself that you feel would be useful in evaluating your application.
	References Please provide the names and other information requested below for two of your professors whom you have asked to write letters of recommendation. Your recommender can include information about your ability as a student as well as an assessment of your research potential. [NOTE: The recommendation letters should be forwarded directly to the address, e-mail, or fax listed at the beginning of the REU Application.]
	Recommender 1
*	Faculty Title:
*	Faculty Name: (first and last name)
*	Department Name:
*	College/University:
*	Faculty Telephone:	(XXX) XXX-XXXX
*	Faculty E-mail Address:
	Recommender 2
*	Faculty Title:
*	Faculty Name: (first and last name)
*	Department Name:
*	College/University:
*	Faculty Telephone:	(XXX) XXX-XXXX
*	Faculty E-mail Address:

	Personal Information Submitting the following information is optional, but provides important information that will be used for reporting statistics to the National Science Foundation. This section of the application form is based on NSF Form 1225.
	Citizenship status	US Citizen Permanent Resident Other immigration status
	Gender:	Female Male
	Which one of these categories best describes your ethnic/racial status?	American Indian or Alaskan Native Asian Black, not of Hispanic Origin Hispanic Pacific Islander White, not of Hispanic Origin Other, not listed
	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

redirect

You may when done, or if you want to start over.