First Name
Last Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail

Citizenship: (Only US citizens & permanent residents are eligible)

US Citizen Permanent Resident

Academic Information

District                   Grade Level Currently Teaching 

Summarize your professional experience. (years teaching, subjects, and schools) (Max 100 words)

List your degrees & colleges. (Max 100 words)

Describe your experience in classroom innovation. (Max 200 words)

List participation in other professional development workshops. (Max 100 words)

List honors & awards. (Max 100 words)

Personal Statement

In 2000 characters (including spaces) please specify why you want to participate in the summer research program, including your goals for the summer, the strengths you bring, and what you hope to gain.
 

Research Interests

Select the research program that most interests you. Provide a brief summary of why you would like to work with these faculty.

Research Program Choice:

University of Arizona University of California San Diego Caltech

Explanation: (Max 100 words)

Demographic Information

The purpose of this section is to collect demographic information for the granting agency (the National Science Foundation). Completion is voluntary. Failure to complete this section of the application will not adversely affect your application to this program.

Gender:

Female
Male
Decline to State

Ethnicity/Race

Not Known  American Indian/Alaskan Native  African American    
Hispanic       White           Asian                 Hispanic or Latino                Other           Decline to State               

Are you disabled?

Yes         No         Decline to State

Mother's Education Level

Please select Some High School High School Graduate Some College 2yr College Degree 4yr College Degree Postgraduate Study Decline to State

Occupation:      Decline

Father's Education Level

Please select Some High School High School Graduate Some College 2yr College Degree 4yr College Degree Postgraduate Study Decline to State

Occupation:      Decline

Other

Percent of minority students enrolled in your current school?

Disclosure Agreement