NIST SURF Program Student Applicant Information

National Institute of Standards and Technology

Student Applicant Information

To be filled out by student applicant and included with completed institutional application

DO NOT SEND SEPARATELY

Name Institution

Email address + quickest contact (cell, apt/dorm phone)

Home Address

Current Class Standing (check only one)

Freshman Sophomore Junior Senior 5^th Year Senior

Applying to SURF Program in: (Please Note: indicate 1^st and 2^nd choices)

(Look under “Research Programs” at the website below for more information)

Materials Science & Engineering/
Center for Neutron Research

Electronics & Electrical Engineering

Physics  Manufacturing Engineering 



Chemical Science & Technology

Center for Nanoscale Science & Technology

Building & Fire Research Information Technology  

Major (Minor) Current Overall GPA

Do you require housing?  Yes  No (your gender)  Male  Female (for housing purposes only)

Students should expect to share a bedroom with one other student

Available for the entire 11-week SURF Program? (5/26/2009 – 8/7/2009)  Yes  No

If no, give availability dates

Limited number of 9-week fellowships available (6/8/2009 – 8/7/2009)

NOTE: All students must attend through the final week in August

Are you a U.S. Citizen?  __YES  or __ NO

If not a U.S. Citizen, are you a Permanent U.S. Resident with a valid Green Card?  ___ YES or __ NO

Checklist:

 Resume

 Two letters of recommendation

 Transcripts (unofficial copies acceptable)

 Personal statement of commitment to participate and description of prioritized research interests

• Verification of U.S. citizenship or permanent legal residence, (e.g. copy of birth certificate, passport, or green card)

Submit to University contact for inclusion with institutional application – DO NOT SEND SEPARATELY

Application Questions: Anita Sweigert, Phone: 301-975-4200, Fax: 301-975-3038

Website: http://www.surf.nist.gov/surf2.htm

NOTE: This form contains collection of information requirements subject to the Paperwork Reduction Act. Notwithstanding any other provision of the law, no person is required to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB control number. The estimated response time for this application information is 2 hours.

The response time includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB Control No. 0693-0042 Expiration Date: 06/30/XXXX