SURF Program Student Application Information

National Institute of Standards and Technology

Application Deadline: February 15, XXXX
APPLICANT INFORMATION
Name:
Last

First

Middle Name

Permanent Address:
Street Address or PO Box, Apartment #, etc.

City

Telephone:

State (Abbreviation)

Zip Code

Email:
Quickest Contact Number (xxx-xxx-xxxx)

Primary email address

Citizenship:
U.S. Citizen
Permanent U.S. Resident (with a valid Green Card)
NOTE: SURF participants MUST be U.S. citizens or Permanent Residents
ACADEMIC INFORMATION
*Please submit unofficial transcripts only.
Name of College/University:
Current Class Standing (check only one):
Freshman
Sophomore
Junior
Major/Minor:
Overall GPA:
Do you have experience with computer languages?
Yes
No

Senior

If so, please describe briefly in the provided space. Please include specific details in your resume.

SURF PROGRAM LOCATION
Which location(s) are you applying to for SURF 20XX? (Note, the SURF Program accepts ~20 applicants
at Boulder and ~120 applicants at Gaithersburg annually)
Boulder
Gaithersburg
Both

**Complete research preference based on previously selected NIST location ONLY.
HOUSING
Gender (for housing purposes only)
If accepted, will you require housing?
Yes for Boulder
Yes for Gaithersburg
No
Female
Male
**Note: Participants should expect to share a bedroom with one other student.
Local students will ONLY receive housing under special circumstances.

Name:
First

Last

University Name

BOULDER SURF RESEARCH PREFERENCE
List (by reference number) the 6 research opportunities which you are most interested in order of preference.
Include opportunities from at least two different divisions. (Go to https://www.nist.gov/surf/surfboulder/research-opportunities for the current list of research opportunities.)
1

2

3

4

5

6

Are you available for the entire 11-week SURF Program in Boulder, CO on May 21, 20XX-August 3, 20XX?
Yes
No
If no, give availability dates. ___________________________ **Total amount of time must span 11 weeks.
NOTE: All students must attend through August 3, 20XX.
GAITHERSBURG SURF RESEARCH PREFERENCE
Select from the dropdown menu, the 2 research opportunities (by laboratory name) in which you are most
interested in order of preference. Try to include opportunities from at least two different laboratories. (Go to
https://www.nist.gov/surf/surf-gaithersburg/research-programs for a description of each laboratory.)
1

2
Select First Research Preference in Gaithersburg
Select Second Research Preference in Gaithersburg

Are you available for the for the entire 11-week SURF program in Gaithersburg, MD?
(May 29, 20XX– August 10, 20XX)
Yes

No

If no, give availability dates. ________________________________
**Limited number of 9-week fellowships available (June 11, 20XX– August 10,
20XX). NOTE: All students must attend through August 10, 20XX.
PREVIOUS SURF EXPERIENCE

Have you participated in the SURF program at NIST previously?
If yes, please indicate: Year (s):
Location:

Yes
No
Boulder
Gaithersburg

Mentor’s Name:
If you were to return, would you prefer to work with the same mentor?
Yes
No
No Preference
SPECIAL SKILLS
Do you have experience working in a laboratory?
Yes
No
If so, please describe briefly in the provided space. Please include specific details in your resume.

List any other special skills not included above (e.g., tutoring, extracurricular activities, leadership positions):

Name:
Last

First

University Name

TERMS & Conditions
Please provide your initials by each statement below to acknowledge that you have read the statements below and
plan to abide by the conditions.
______If invited to participate in the NIST SURF Program, I acknowledge that I must indicate in this application if I
require housing. I will not have the opportunity to request housing once my application is submitted.
______If invited to participate in the NIST SURF Program, I acknowledge that I am required to undergo a
background check which includes fingerprinting.
______If invited to participate in the NIST SURF Program, I acknowledge that I will provide the required federal
identification for entry to NIST on the first day of the program established under the REALID Act of 2005. Drivers'
licenses from the following states and territories will NOT be accepted for entry to NIST: American Samoa,
Arizona, and Louisiana. In addition, only enhanced drivers' licenses (identified by the American flag on the face of
the card) will be accepted from the following three states: Minnesota, New Hampshire, and New York state.
Individuals without licenses from compliant jurisdictions may present alternative forms of identification such as an
unexpired U.S. Passport.

5, 20XX
Checklist:
☐Resume (Important: be sure to include any laboratory skills or computer laguages, etc.)
☐Personal Statement of Commitment to participate (includes research interest)
☐Two letters of recommendation
☐Transcripts (unofficial acceptable)
☐Verificiation of US citizenship or permanent legal residence (e.g. legible copy of birth certificate, passport, or green card)

SURF Program Contact: Dr. Brandi Toliver, Email: [email protected]
Website: http://www.nist.gov/surf
Note: This collection of information contains Paperwork Reduction Act (PRA) requirements approved by the Office of Management and Budget
(OMB). Notwithstanding any other provisions of the law, no person is required to respond 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 PRA unless that collection of information displays a
currently valid OMB control number. Public reporting burden for this collection is estimated to be 30 minutes per response, including 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: 10-31-2018
Privacy Act Statement
Authority: 15 U.S.C. § 278g-1(a)
Purpose: The National Institute for Standards and Technology (NIST) hosts the Summer Undergraduate Research Fellowship (SURF) which
provides an opportunity for the NIST laboratories to encourage outstanding undergraduate students to pursue careers in science and technology.
This information collection will serve as the application and submission process for the SURF program.
Routine Uses: NIST will use the information collected to perform the requisite reviews of the applications to determine eligibility, and to meet
programmatic requirements. Disclosure of this information is also subject to all the published routine uses as identified in the Privacy Act System
of Records Notices: NIST-1: NIST Associates.
Disclosure: Furnishing this information is voluntary. When you submit the form, you are indicating your voluntary consent for NIST to use of
the information you submit for the purpose stated.