SURF Application Form

Smith SURF! 2008 Application Form

Please complete and submit the following application form. Please constrain you input to a single line (255 characters max), i.e. do not insert carriage returns. Use the Tab key to move between fields. All fields (other than last two) are required, please don't submit the form until you have all the information necessary.

Preferred first name: Last name:

Legal name, if different: Class:

Smith ID# (if you don't have one, type name of your college):

Major(s) - declared or prospective:

Mailing address (campus box):

Note: If awarded, this is where your check will be mailed (unless you set up direct deposit). If you are graduating in spring 2008, do NOT enter a campus box, as it will be canceled when you graduate. Enter a non-Smith mailing address instead.

Email address: Phone:

Summer research advisor (sponsor):

Title of proposed research (title cap):

Field of study:	Astronomy	Chemistry	Environmental Science	Neuroscience
	Biochemistry	Computer Science	Geology	Psychology
	Biology	Engineering	Math & Statistics	Physics

What date do you anticipate starting (best guess):

Status: US Citizen Permanent resident (green card) Foreign resident

How many weeks are you applying for (standard is 10 weeks):

Optional - Name of grant(s) you'd like to be considered for (your advisor may have a suggestion; it could be the name of your advisor's own funding source):

Optional - Any other comments?

1. PRINT

Before submitting this form, print a copy of the completed form and attach it as a cover page to your application package, as instructed on the Smith SURF! web page.

2. SUBMIT