University of California, Berkeley

Thank you for your interest in the 2018 UCB-HBCU Program. Please answer all of the questions in their entirety, paying particular attention to the essays at the end of the application. Please note that once you start the online application, you will be asked to submit the complete application. You will not be able to save your information. If you are not ready to submit your complete application, you may return to the online application to resubmit your application.

All of your supporting documents, which includes: 1) transcripts from all institutions you have attended;and 2) two letters of recommendation, must be RECEIVED by the UCB-HBCU Program office no later than Thursday, November 30, 2017. These documents may be submitted via email, fax, or mail.

If you have any questions regarding the program or application, please contact Kedrick Perry at e3sprograms@e3s-center.org or 510-664-4467

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1. First Name

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2. Last Name

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3. Email Address

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4. Permanent Street Address

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5. City

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6. State

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7. Zip code

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8. Primary/Cell Phone Number

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9. Alternative Phone Number

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10. Date of Birth (MO/DA/YEAR)

DEMOGRAPHIC INFORMATION: Why is this information being requested? Collection of this information is authorized by the NSF Act of 1950, as amended, 42 U.S.C. 1861, et seq. Demographic data allows NSF to gauge whether our programs and other opportunities in science and technology are fairly reaching and benefiting everyone regardless of demographic category; to ensure that those in under-represented groups have the same knowledge of and access to programs and other research and educational opportunities; and to assess involvement of international investigators in work supported by NSF (E3S National Science Foundation Cooperative Agreement No. 0939514).

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11. Citizenship Status (please note only US Citizens, Nationals, and Permanent Residents are eligible for the UCB-HBCU Program)

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12. Gender

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13. Are you of Hispanic, Latino, Chicano, or Spanish origin?

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14. Race (check all that apply)

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15. Disability

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16. Veteran

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17. Highest Education Level of Mother/Parent-Guardian I

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18. Highest Education Level of Father/Parent-Guardian II

EDUCATION BACKGROUND

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19. Undergraduate Institution

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20. Cumulative Grade Point Average (GPA)

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21. Major Grade Point Average (GPA)

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22. GPA Scale

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23. Academic Major

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24. Current Academic Level

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25. Anticipated Graduation Date

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26. What is your highest degree objective?

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27. List any educational and/or non-educational honors, awards, scholarships, prizes you have received.

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28. Are you currently receiving, or have you recently received a Pell grant?

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29. Are you a member of one of the following programs: LSAMP, McNair, STARS, or MARC?

RESEARCH INTERESTS

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30. Have you participated in other research programs?

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31. If you answered YES, to the above question, please provide the name(s) of the programs and the institutions that sponsored them.

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32. The UCB-HBCU Program is a partnership between 9 professors across 4 research centers at UC Berkeley. Please visit the UCB-HBCU faculty list (http://bit.ly/2xfGb0r), and select the professors you are interested in working with.

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33. UCB-HBCU has summer intern positions available at 4 research centers: CIAN (http://www.cian-erc.org/), E3S (https://e3s-center.berkeley.edu), NASCENT (http://nascent-erc.org/), and TANMS (http://www.tanms-erc.org/). Please rank the following centers from the most preferable (1) to the least (4)

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34. Essay #1: Please explain why you wish to conduct summer research with the faculty you selected and how this relates to your overall interests and goals. Please be specific about your particular area of interest. (Maximum 500 words)

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35. Essay #2: Please describe a recent challenge you have encountered in your life, how you overcame it, and what you learned about yourself and others as a result of the experience. (The experience can be taken from any aspect of your life; it does not need to be related to academics) (Maximum 500 words)

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36. Essay 3: Describe your reasons for wishing to conduct research this summer and your career goals after graduating from your undergraduate institution. In addition, please identify the contributions you wish to make to your chosen field of study as well as your community. This statement gives the reviewers a greater understanding of your academic, personal, and professional qualifications to participate in the UCB- HBCU Program. (Maximum 500 words)

References: Please provide the names, position and email addresses of your two references. Please let your recommenders know that their letters must be RECEIVED by November 30, 2017.

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37. First Recommender Name and Position:

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38. First Recommender Email Address:

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39. Second Recommender Name and Position:

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40. Second Recommender Email Address:

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41. The research program will take place for 9 weeks from June 7th to August 10th. Students accepted into the program will be expected to conduct research full-time, by this we mean a minimum of 40 hours per week.

Are there any dates from June 7th to August 11th when you are not available?

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42. Are you able and willing to devote a MINIMUM of 40 hours per week on your research project?

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43. Research Program participants cannot work or be enrolled in courses, including online courses, unless there are extenuating circumstances. Do you plan to work or enroll in courses while you are in the Research Program?

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44. All research participants are expected to live on campus in provided housing during the entire summer program, including weekends, unless there are extenuating circumstances and you receive prior permission. Can you live on campus for the entire program?

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45. Are you applying to any other summer programs?

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46. I understand that as part of the application process applicants may need to speak/meet with prospective faculty mentors and/or Summer Research Program staff

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47. How did you learn about the UCB-HBCU Program?

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48. The UCB-HBCU is affiliated with the Center for Energy Efficient Electronics Science (E3S) and E3S is one of 14 Science and Technology Centers (STC) throughout the country. Some of these centers have similar fields of research as the UCB-HBCU program, and most offer Summer Research Programs. If your application is not selected for the UCB-HBCU, would you like to be considered for a REU position at another STC?

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49. I hereby certify to the best of my knowledge that all information submitted on this application and in the attached required documents including essay(s) is accurate, complete and my own work. I also certify that the Transcript(s) accurately reflects my grades.

I understand that if I knowingly provide incorrect information, I will, if accepted, be immediately removed from the UCB-HBCU Program (as applicable) and required to reimburse all costs of services provided to me.

By typing your name below, you are agreeing to the above statement.

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50. Date

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