Personal Information: 2013 Summer Chemistry Research Fellowship Application

The form and your answers may be sent to any of the listed faculty participating in this program.

"Please note that information provided in this application may be used to report statistics to the National Science Foundation or other reporting agencies in an aggregate report. All information provided will remain confidential."

Personal and contact information

* 1. First Name:

* 2. Last Name:

* 3. Are you a U. S. citizen or permanent resident?

* 4. Gender?

* 6. Email Address

* 7. Phone number where you can be reached after classes end in Spring 2011

* 8. Address where you can be reached after classes end in Spring 2011

* 9. Your Current School

* 12. List the chemistry courses you have taken, including those you are currently enrolled in

* 13. continue listing courses here

* 14. What is your career goal?

* 15. What do you hope to gain from a summer research fellowship?

Please send this application and have a copy of your transcript and two letters of recommendation sent by March 15, 2013

The above materials or inquiries may be sent to nsftim@nku.edu

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