UCORE Application


	:	UCORE Overview
	:	Eligibility and Application
	:	Past Projects
	:	2009 Projects
	:	Contact Information

	Support provided by: Community College Partners:





Online Application Form
Due on or before February 27, 2009



Personal Information
Title:
First Name:
Middle Initial:
Last Name:
Email Address:
Re-enter to confirm your email:

	Current Address at School:
Street or dormitory:
City:
State:
ZIP:
Phone (include area code):

	Home (Permanent) Address:
Home Address:
City:
State:
ZIP:
Phone (include area code):

College/University Information
College or University currently attending:
Other Colleges / Universities attended:
Your summer availability in 2009:
From (MM/DD/YYYY):
Until (MM/DD/YYYY):
How did you hear about UCORE? Please check all that apply.	In a class At an event From a student who has participated in UCORE From an instructor or professor From an advisor From a poster or flyer or card From a website Other (describe):


Note: If you cut and paste into the fields below, use plain text only (no special characters or graphics). If you encounter an error submitting your application, most likely the problem is in these fields.



Statement of Purpose: Why would you like to participate in this program?


Please list any awards, honors, or other notable accomplishments.


Briefly outline your current goals and proposed career path.


What do you hope to be doing five years from now?


Briefly describe the college/educational background of your immediate family.


Have you had any experience in a science research program?

If 'yes,' please describe.


Academic Information

Please give course name (e.g. Math 95), credit hours granted and grade received for each subject listed below. Include courses that you anticipate completing by the end of spring term 2009.
Once you have successfully submitted this form, you will receive information on where to mail a copy of your transcripts. An unofficial copy is acceptable.

Science lecture courses:

Science laboratory courses:

Math courses:

Overall GPA:

To help the Program comply with our commitment to the National Science Foundation, the following demographic information is requested. Provision of demographic information is strictly voluntary and will not affect consideration of your application. While providing the information is voluntary, we urge your cooperation in this matter and thank you in advance for your assistance.
Gender:
Race:
Ethnicity:
Disability:
Citizenship:

References

Two references are required. At least one of your references should be a college instructor or professor. It is your responsibility to contact your references and request that they complete the online recommendation form.

Waiver: By checking 'Yes' below, I expressly waive any rights I might have to access this recommendation under the Family Educational Rights and Privacy Act of 1974, or any other law, regulation or policy. I understand that I am not required to execute this waiver and my application will be reviewed whether or not I check here.
Please check either Yes or No:	Yes No

	Reference 1:
Title:
First name:
Last Name:
Position / Affiliation:
Street Address:
City:
State:
ZIP:
Phone (include area code):
FAX (include area code):
Email:

	Reference 2:
Title:
First name:
Last Name:
Position / Affiliation:
Street Address:
City:
State:
ZIP:
Phone (include area code):
FAX (include area code):
Email:

Important! Please review your application now. Do NOT press the 'Submit' button until the form has been COMPLETELY filled out.