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Address (home):
- City:
ST: ZIP:
Phone:
Email:
Citizenship (choose one) :
Disability/Ethnicity/Race
The National Science Foundation asks us to collect this information for reporting purposes. Your name will not be included in any reporting of demographic data.
Disability (select one or more)
Hearing Impairment
Visual Impairment
Mobility/Orthopedic Impairment
None
Other (Enter Description)
Ethnicity (choose one)
Hispanic or Latino
Not Hispanic or Latino
Do not wish to provide
Race (select one or more)
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Do not wish to provide
Race Definitions:
American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America) & who maintains tribal affiliation or community attachment.
Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American. A person having origins in any of the black racial groups of Africa.
Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Hispanic or Latino. A person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race.
White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Why This Information Is Being Requested:
Collection of this information is authorized by the NSF Act of 1950, as amended, 42 U.S.C. 1861, et seq. Demographic data allows NSF to gauge whether our programs and other opportunities in science and technology are fairly reaching and benefiting everyone regardless of demographic category; to ensure that those in under-represented groups have the same knowledge of and access to programs and other research and educational opportunities; and to assess involvement of international investigators in work supported by NSF. The information may be disclosed to government contractors, experts, volunteers and researchers to complete assigned work; and to other government agencies in order to coordinate and assess programs. Your name will not be included in any reporting of demographic data.
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Education
High School: Year
Graduated: GPA:
College:
Graduating Year: GPA:
- Select your primary major/concentration, along with up to two secondary majors, minors, or
concentrations that best describe your degree.
Primary Major:
Other Concentration Not Listed:
Secondary Major:
Other Concentration Not Listed:
Another Secondary Major:
Other School Attended (if any):
Dates Attended: GPA:
Relevant Coursework
Materials Science, Physics, Chemistry, Mathematics, Computer Science, etc.
Note courses you are taking in the spring term and include an official transcript.
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Relevant Research Projects:
Work Experience:
Honors/Awards:
Research Project Interest(s):
Please indicate the research area(s) you are interested in pursuing over the summer.
What attracted you to this program?
The Industrial Internship Program is intended to provide
undergraduates with an introduction to current scientific challenges
as a way of understanding of how research is conducted. It is useful
to know what attracted you to this program or any other information
that does not neatly match one of the categories above. After all, research
is done by individuals working with one another.
Name two references:
Please include the name, address, telephone number, and email address of the persons who are writing letters of recommendation for you.
Please be sure to send transcripts under separate cover to the address listed below.
Check here if you have requested an official transcript be sent to the Center.
Kathryn Hollar, PhD
Director of Educational Programs
Division of Engineering & Applied Sciences
Harvard University
206A Pierce Hall
29 Oxford Street
Cambridge, MA 02138
Deadline: Friday, February 25, 2005
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