Preferred first name:     Last name:

Legal first 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 this spring, 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):

What date do you anticipate starting (best guess):

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

Have you been mentor or mentee in AEMES or Peer Mentoring program?  Yes   No    

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! Application page.

2. SUBMIT

By submitting this form, I commit that I will respond to the SURE survey in August, and submit my research abstract before I end my summer program or August 22nd, at the very latest.