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Application

Application Deadline:

February 15, 2010 for May 25, 2010 start date

A. CONTACT INFORMATION:

Applicant Name:

Last: First:

Permanent Address:

Street:

City: State:

Zip Code:

Current Address (if different from permanent address):

Street:

City: State:

Zip Code:

Home Phone: Cell:

Email:

B. HOME UNIVERSITY OR COLLEGE INFORMATION:

If you have attended college, please fill out this section. Otherwise, proceed to section B. 2.

B. 1.

Name of University/College:

Major:

Minor (if applicable):

Current Year: Freshman Sophomore Junior Senior

Cumulative Grade Point Average:

If applicable: Graduation Date (mm/yy): / Degree Awarded:

B. 2.

Intended Major:

Intended Minor (if applicable):

Interest in Masters' Degree: Yes No

If yes, what program/specialty:

Interest in PhD: Yes No

If yes, what program/specialty:

C. MILITARY AND/OR OTHER CAREER INFORMATION (please complete for last three positions held):

Dates Employed: / to /

Rank:

Position(s) Held:

Work Performed:

Computer Skills:

Other Skills:

Dates Employed: / to /

Rank:

Position(s) Held:

Work Performed:

Computer Skills:

Other Skills:

Dates Employed: / to /

Rank:

Position(s) Held:

Work Performed:

Computer Skills:

Other Skills:

D. RESEARCH INTERESTS:

Have you engaged in one semester or more of research?: Yes No

If you replied "yes" to the previous question, please describe your research experience, including approximate dates:

Your ideal summer research project would involve (check all that apply):

Software development Survey design and development Human subject data collection and analysis Prototype design and development Electronics circuitry and schematic design

Do you have familiarity with any of the following (check all that apply)?:

Access or other database software C/C++ Electronics HTML Java Linux/Unix Matlab MediaWiki OpenGL PostGres SolidWorks SQL Visual Basic Other:

E. RESEARCH PROJECT SELECTION:

I am most interested in working on the following projects:

Top Choice Second Choice Third Choice

F. DEMOGRAPHIC INFORMATION:

Information you choose to provide with respect to factors such as gender, race/ethnicity, disability status, age, or national origin is optional and will remain confidential. This information is, however, of value to us and to the National Science Foundation in tracking the participation of various groups in the programs it funds. Please check all categories that apply to you. You may clarify your responses in your statement of interest or in a separate e-mail message.

Gender: Male Female

Date of Birth:

Race/Ethnicity:

African American Asian Caucasian Hawaiian Native/Pacific Islander Hispanic/Latin Native American/Alaskan Native Other:

Disability Status:

Hearing Impairment Visual Impairment Mobility/Orthopedic Impairment Other:

G. ADDITIONAL REQUIREMENTS:

I will need housing in Pittsburgh: Yes No

If yes, I would be interested in complimentary housing in a dorm for 10 weeks: Yes No

Due to family or health concerns, I would prefer to reside in an apartment off campus: Yes No

At this time you should email Mary Goldberg your resume, personal statement*, and 2 letters of recommendation.

*Your personal statement should include:

Why you are interested in participating in the REES program;
What specific research area you are interested in and why;
A brief description of any relevant courses you are taking or have taken;
An explanation of any relevant career experience (military or otherwise);
What you will contribute to the REES program;
Your career objectives

H. OPTIONAL SURVEY:

How did you hear about our program (check all that apply)?

Brochure Direct Mailing Instructor/Faculty

Human Engineering Research Labs Website Military Counselor

Online Internship Clearinghouse Quality of Life Technology Website

Student Other:

Thank you for completing the application form!