Loyola University Chicago

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Loyola University Chicago

Department of Chemistry and Biochemistry

Research Experience for Undergraduates 2013

Application Form

First Name: Last Name:
Current Address:Permanent Address: (if same ignore)
Address: Address:
Address2: Address2:
City: City:
State: State:
Zip: Zip:
Phone: Phone:
E-mail:    
Colleges or Universities attended (with dates):
#1 Dates:
#2 Dates:
#3 Dates:
#4 Dates:
Current Academic Status:
Freshman Sophomore Junior
Major(s): Minor(s):
Expected Graduation Date:
Immediate goal after graduation (pick best one):
Graduate School
Medical School
Dental School
Law School
Get a job
Other
Undecided
Citizenship:
Yes
No
If not a US citizen, indicate US immigration status:
Gender*:
Male Female
Race*:
African-American
Asian
White
Native American/Alaskan Native/Hawaiian Native
Ethnicity*:
Hispanic/Latino Not Hispanic/Latino
*Providing information on Gender, Race and Ethnicity is optional. Please note that information provided in this application may be used to report statistics to the National Science Foundation or other reporting agencies in an aggregate report. All information will remain confidential.
Names, addresses & e-mail addresses of three people whom you have asked to write letters of recommendation. Please ask them to submit their letters via e-mail to cgrimm@luc.edu
Name:
Address:
Email:
Name:
Address:
Email:
Name:
Address:
Email:
Preferred research mentor: List in order the names of the three Loyola professors you want to work with during the summer of 2011:
#1:
#2:
#3:
Copy/Type into the space below a short one-page letter summarizing your career goals. Indicate how you think that participation in this program will assist you in attaining these goals.
Please have a transcript sent to:

NSF-REU Program
Department of Chemistry
Loyola University Chicago
1032 W Sheridan Road
Chicago, IL 60660
For further information, please e-mail Dr. Ken Olsen, REU Program Director, at kolsen@luc.edu.



Loyola

Department of Chemistry & Biochemistry
Loyola University Chicago · 1032 W. Sheridan Rd., Chicago, IL 60660
Phone: 773.508.3100 · Fax: 773.508.3086

Notice of Non-discriminatory Policy