Summer Research Experience for Teachers Program Online Application

Please fill out the application completely. If you have any questions or comments, please contact rzellin@princeton.edu. All fields marked with an * are required.

Applications due: April 30th; Acceptance Notification: May 15th

Personal Information
Salutation *	Mr. Ms.
First Name *
Middle Initial
Last Name *
Email Address *
Home Address *
City *
State *	AA AE AK AL AP AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY XX    Zip *
U.S. Citizen/Permanent Resident *	YES NO
NSF Diversity Reporting Information: The information you choose to provide with respect to factors such as gender, race/ethnicity, disability status, age, or national origin is optional and will remain confidential. This information is, however, of value to us and to the National Science Foundation in tracking the participation of various groups in the program it funds. Please check all categories that apply to you.
Gender	Male Female
Date of Birth	Month 01 02 03 04 05 06 07 08 09 10 11 12   Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930
Race (select all that apply)	African American/Black Asian American Indian Alaskan Native Pacific Islander Native Hawaiian White/Caucasian
Are you Hispanic/Latino? (Hispanic/Latino: Mexican, Puerto Rican, Cuban, Central or South American or other Spanish origin or culture, regardless of race)	YES NO
Do you have a disability?	YES NO
If yes, please specify
I choose not to provide diversity information at this time.
How did you hear about our program? (check all that apply) *	Brochure/Flyer Department Email Booth at a conference NSF Website MIRTHE Website Colleague Previous MIRTHE RET fellow Previously applied to MIRTHE RET Previously participated at MIRTHE RET Other
Employment Information
Job Title/Occupation *
School District *
Name of School *
School Address *
City *
State *	AA AE AK AL AP AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY XX Zip *
Work Phone *	-
Work Fax *	-
Current teaching assignment *
Grade(s) teaching *
Number of years teaching experience *
List of courses you anticipate teaching next fall
Please indicate your experience with research-based curriculum materials
Research based curriculum Materials used with students Number of years 1 2 3 4 5
Have you ever participated in a RET program before *	YES NO
If yes, please list the program name and year(s) participated
Please write a short description as to why you would like to participate in this program and how do you feel this experience will benefit both you and your students * (500 words or less)
Education Information List all colleges and universities you have attended, in chronological order. If you have been teaching for less than 10 years, please provide a transcript from all colleges or universities from which you have obtained a degree. Unofficial transcripts and photocopies of official transcripts are acceptable. If you have been teaching for 10 years or more, you do not have to submit transcripts.
Name of Institution *
Type of Institution *	Please Select Community College Liberal Arts College University Other
City *
State *	AA AE AK AL AP AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY XX Zip *
Dates of Attendance *	From: Month 01 02 03 04 05 06 07 08 09 10 11 12   Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
	To: Month 01 02 03 04 05 06 07 08 09 10 11 12   Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Degree *
Major *
Year of Graduation *	Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
GPA *
Please provide the same information for other educational institutions attended
Please describe the research areas of interest to you and relevant courses you have taken in those areas. Please review the list of Suggested Research Topics and identify the ones that are of particular interest to you. *
Please list any honors, prizes, publications, or anything else you would like us to know about yourself. *
Please select your desired REU site * (must be within commuting distance)	Please Select Princeton University City College of New York Johns Hopkins University Rice University Texas A&M University University of Maryland, Baltimore County
Letters of Reference Please provide two letters of reference. Note: An email will be automatically generated and sent to each email address provided requesting a letter of recommendation. Letters of reference should be given from your Principal, Assistant Principal, Department Head, Science Coordinator, or prior RET fellow.
1st Reference Position *	Please Select Principal Assistant Principal Department Head Science Coordinator Prior RET Fellow
1st Reference Name *
1st Reference Telephone *	-
1st Email Address *
2nd Reference Position *	Please Select Principal Assistant Principal Department Head Science Coordinator Prior RET Fellow
2nd Reference Name *
2nd Reference Telephone *	-
2nd Email Address *