2016-REU

Before you begin your application:

Please complete the following questions to begin your application. Note that in addition to these questions, you will also need to send an unofficial copy of your transcript along with your personal statement to Ann.Murkowski@SeattleColleges.edu. In addition, you should ask your two references to forward their letters of reference to this same address. All materials must arrive by April 18, 2016.

Thank you for your interest in our program, and good luck! All applicants will be notified once the selection process is complete. Finalists will be invited to interview, either in person or by phone, before the final awards are made.

Question Title

* 1. First Name:

Question Title

* 2. Last Name:

Question Title

* 3. Which college do you currently attend?

Question Title

* 4. Student ID #:

Question Title

* 5. Home Address:

Question Title

* 6. Phone #:

Question Title

* 7. Email:

Question Title

* 8. Birthdate (MM/DD/YYYY)

Question Title

* 9. Ethnicity (check all that apply). Note that this information does not affect your application; it is used to provide data to our funding organization, the National Science Foundation.

African

African American/Afro-Caribbean

Alaskan Native/Native American

Caucasian/White

Asian/Asian American

Latin American/Hispanic/Chicano

Other (please specify)

Question Title

* 10. Check all that apply:

English is my second language.

I am a resident of the State of Washington.

I am a resident of public or Section 8 housing.

I am homeless or near homeless.

I am an international student studying under an F-1 or M-1 student visa.

I am a refugee.

I am a veteran.

I am a female student in engineering, physical science or math.

I am registered as a disabled student with our Disability Support Services.

Neither of my parents or guardians graduated from a four-year college or university.

Question Title

* 11. I am/will be a full-time student at my community college for the following quarters (check all that apply):

Summer 2016

Fall 2016

Winter 2017

Spring 2017

Summer 2017

Fall 2017

If you will be attending classes during the Summer 2015 quarter, please enter the dates of the first and last day of your quarter below.

Question Title

* 12. List the four-year universities where you plan to apply for transfer, and indicate approximately when you plan to transfer. (Note that to be eligible for this program, you must have at least one full year left at your community college.)

Question Title

* 13. Current course of study:

Environmental Science

Marine Science

Engineering

Mathematics

Chemistry

Computer Science

Geology

Biology

Physics

Other (please specify)

Question Title

* 14. Total credits completed as of Winter 2016 (see “Cum: Cr Earn” at bottom of transcript):

Question Title

* 15. Your college level GPA (“CLM: GPA” on bottom right corner of your transcript):

Question Title

* 16. Education experience:
(Names and dates of schools attended, degrees pursued and completed, cumulative GPAs for each):

Question Title

* 17. Two most recent jobs (employers, dates, job titles):

Question Title

* 18. College & Community Activities:

Question Title

* 19. Hours per week you spend working/work-study:

Question Title

* 20. Hours per week you spend volunteering with on or off-campus organizations:

Question Title

* 21. Recommendation #1 (Name, Title, Email, Phone):

Question Title

* 22. Recommendation #2 (Name, Title, Email, Phone):

Question Title

* 23. Please click the boxes below to indicate that you have read, understood, and agreed to all of the items below.

I understand that this application will not be considered unless all required materials are received, and the application is signed and dated on or before April 18, 2016.

I realize that every eligible applicant will not receive an award.

I also understand that applications are confidential and that my application materials will not be returned.

I understand that, if selected, my participation in this program will require at least seven trips to Seattle for workshops and data collection over the course of the year. I agree to be available for these critical meetings and to communicate regularly with my mentor in a prompt, professional manner.

I also hereby swear that all information provided in my application is true and complete to the best of my knowledge. If determined that any of the information I provided is false, altered or forged, I understand that my application will not be considered and if awarded a stipend, the award rescinded. In addition, the misconduct maybe reported to the Vice President for disciplinary sanctions under WAC 132F-121-110.

Please enter your name below as your digital signature.

Question Title

* 1. First Name:

Question Title

* 2. Last Name:

Question Title

* 3. Which college do you currently attend?

Question Title

* 4. Student ID #:

Question Title

* 5. Home Address:

Question Title

* 6. Phone #:

Question Title

* 7. Email:

Question Title

* 8. Birthdate (MM/DD/YYYY)

Question Title

* 9. Ethnicity (check all that apply). Note that this information does not affect your application; it is used to provide data to our funding organization, the National Science Foundation.

Question Title

* 10. Check all that apply:

Question Title

* 11. I am/will be a full-time student at my community college for the following quarters (check all that apply):

Question Title

* 12. List the four-year universities where you plan to apply for transfer, and indicate approximately when you plan to transfer. (Note that to be eligible for this program, you must have at least one full year left at your community college.)

Question Title

* 13. Current course of study:

Question Title

* 14. Total credits completed as of Winter 2016 (see “Cum: Cr Earn” at bottom of transcript):

Question Title

* 15. Your college level GPA (“CLM: GPA” on bottom right corner of your transcript):

Question Title

* 16. Education experience:(Names and dates of schools attended, degrees pursued and completed, cumulative GPAs for each):

Question Title

* 17. Two most recent jobs (employers, dates, job titles):

Question Title

* 18. College & Community Activities:

Question Title

* 19. Hours per week you spend working/work-study:

Question Title

* 20. Hours per week you spend volunteering with on or off-campus organizations:

Question Title

* 21. Recommendation #1 (Name, Title, Email, Phone):

Question Title

* 22. Recommendation #2 (Name, Title, Email, Phone):

Question Title

* 23. Please click the boxes below to indicate that you have read, understood, and agreed to all of the items below.

* 16. Education experience:
(Names and dates of schools attended, degrees pursued and completed, cumulative GPAs for each):