Personal Information
Salutation *
Mr. Ms.
First Name *
Middle Initial
Last Name *
Primary Email Address * a confirmation email will be sent when we receive your application
Alternate Email Address
Current Address *
City *
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ME
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MT
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Zip *
Permanent Address
(if difference from above )
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CT
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DE
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HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
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OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
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Zip
U.S. Citizen/Permanent Resident *
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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
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Year
1995
1994
1993
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1991
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1989
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1986
1985
1984
1983
1982
1981
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1975
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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
Poster
Booth at a conference
NSF Website
MIRTHE Website
Instructor/Faculty
Previous MIRTHE REU student
Previously applied to MIRTHE REU
Previously participated at MIRTHE REU
Other
College/University Information
College/University *
City *
State *
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AL
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
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Status * (enrollment for next fall )
Freshman
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Senior
Major *
Minor
Cumulative GPA *
Expected date of graduation *
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
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29
30
31
Year
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Please list any honors, prizes, publications, or anything else you would like us to know about yourself.
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 select your desired REU site * (1 most desirable – 6 least desirable. MIRTHE faculty will make the final decision. )
Select
1
2
3
4
5
6
Princeton University
Select
1
2
3
4
5
6
City College of New York
Select
1
2
3
4
5
6
Johns Hopkins University
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1
2
3
4
5
6
Rice University
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1
2
3
4
5
6
Texas A&M; University
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1
2
3
4
5
6
University of Maryland, Baltimore County
Faculty Reference Please give one faculty reference. Note: An email will be automatically generated and sent to the address provided requesting a letter of recommendation. Please list someone you are certain will provide a letter of recommendation.
Faculty Title *
Professor
Doctor
Mr.
Ms.
Faculty Name *
Faculty Telephone *
-
Faculty Email Address *