Last        First          MI
                       Name  * *  
         College/University  *
Highest Degree Granted at your university: * Assoc.  BS/BA  M.S. Ph.D. 
              Major / Minor  
           Fall 2012 Status* So    Jr    Sr
  US Citizen/Perm Resident?* Yes   No
   Expected Graduation Date* 
             Cumulative GPA*  on a scale of 
     GPA for Science & Math*  (estimate, on same scale)

Science/Math Course Grades (one per line.  E.g. "Physics 1: A"):*

            Email *
Telephone Numbers *
              FAX  
     Web Page URL 

Mailing address on March 1, 2012

   Street address *
  Address (cont.) 
             City *
   State/Province *
  Zip/Postal code *
          Country 

Home/Permanent Address

   Street address 
  Address (cont.) 
             City 
   State/Province 
  Zip/Postal code 
          Country 

Research Area Preferences (check all that apply) *

Solar System	Instrumentation
Stars and Stellar Systems	Radio Astronomy
Galactic Structure / ISM	Space Physics
Galaxies and Cosmology	Active Galaxies

If you'd like to work in a specific area or with a specific mentor, please enter that information here:

Computer OS's, languages, & packages. Please check all that you have a working knowledge of:

Windows	IRAF	Excel	SM	FORTRAN
Linux/Unix	IDL	Mathematica	Perl	C
MacOS	AIPS	MATLAB / Octave	HTML	C++
TeX/LaTeX	Python	Labview	Java	C#

Other:

Scientific and related employment since High School, including assistantships:

Honors and Awards:

Other Relevant Experience:

Hobbies, Sports, etc.

Personal Essay. Please write a one-page (approx. 250-750 words) essay about your background, interest in astronomy, and why you think you would be a good candidate for this program. Edit on your home computer, then cut-and-paste into this window (i.e., don't send us a first draft!): *

Arrange to have two faculty members complete letters of reference. If possible, we ask that letters of reference be submitted via email to Dr. Matt Wood, SARA REU Program Director, at the address wood 'at' fit.edu. Materials should be received by the application deadline.

Reference #1:

             Name *
            Title *
     Dept address *
  Address (cont.) 
             City *
   State/Province *
  Zip/Postal code *
            Phone *
            Email *
      Years Known *
     Relationship *

Reference #2:

             Name *
            Title *
     Dept address *
  Address (cont.) 
             City *
   State/Province *
  Zip/Postal code *
            Phone *
            Email *
      Years Known *
     Relationship *

How did you first learn about the SARA REU internship program? *

Faculty/Advisor	SARA Website	NSF Website
REU Poster	Friend	AAS Meeting
Other (please specify):

If you have any special instructions or comments, please enter them here.

Submitting the following information is optional, but provides important information that will be used for reporting statistics to the National Science Foundation. This section of the application form is based on NSF Form 1225.

Gender  Male    Female

Which one of these categories best describes your ethnic/racial status? (If more than one category applies, use the category that most closely reflects the person's recognition in the community.)

American Indian or Alaskan Native	Asian
Black, not of Hispanic Origin	Hispanic
Pacific Islander	White, not of Hispanic Origin

Yes No

If yes, please explain briefly

Yes No