2018 CSTEP Summer Research Program Application
To be completed by Thursday, March 15, 2018. You must also complete the (A) Cover Sheet and (B) submit your two Letters of Recommendation contact sheets. Hard copies are available in the CSTEP Office, 222 Norton.
Are you currently a CSTEP student?
Salutation
First Name
Your answer
Last Name
Your answer
Email Address
UB Email Address
Your answer
Person Number
12345678
Your answer
Gender
Ethnicity
Date of Birth
mm/dd/yyyy
Your answer
Class Level
Major
If you selected "Other" with the previous question, please list here:
If not, write "N/A"
Your answer
GPA
Your answer
Total Number of Credits
Your answer
Are you a United States citizen?
If you answered "No" to the previous question, are you a permanent resident?
If you are a permanent resident, please enter your Alien Registration #:
If not, enter "N/A"
Your answer
Will you require on-campus housing for the summer?
Local or Campus Address
123-B Dorm Hall
Your answer
Local City, State, Zip Code
Your answer
Local/Mobile Phone
(555) 555-5555
Your answer
Permanent Address
Example: 567 CSTEP Rd.
Your answer
Permanent City, State, Zip Code
Your answer
Parent(s)/Guardian(s) Name(s):
Example: Mr. John Doe; Mrs. Jane Doe
Your answer
Emergency Contact Person (Name)
Example: Jerry Doe
Your answer
Emergency Contact Phone Number & Relationship to you
Example: (555) 555-1234, Parent
Your answer
How did you hear about the CSTEP Summer Research Program?
Your answer
Anticipated Graduation Date:
Example: 06/2017
Your answer
Highest degree you plan to pursue:
Required
In what area(s) or discipline(s) do you intend to pursue your highest degree?
Your answer
Please list courses (with grades) that you have taken that you believe would benefit you during your CSTEP summer research experience:
Example: BIO201 B+, CHE201 A-, MTH141 A, PHY260 A
Your answer
Please list other programs that you have participated in or currently participate in:
Required
Have you participated in PRE-collegiate program? If yes, which one(s)?
Required
Area of research you are interested in:
Examples: Nanotechnology; Thyroid Cancer; ADHD; Diabetes
Your answer
Have you identified a faculty mentor? If so, please provide their name and contact information:
Example: Yes. Dr. Janice Doe, School of Pharmacy, 555 Cstep Hall, (555) 555-5555
Your answer
Do you have any experience conducting research? If yes, please describe:
Example: Biology Lab with Dr. John Doe, Research Intern, March-June 2012
Your answer
List extracurricular or community activities:
Your answer
Reference #1: Please list their Name, Title, Address, Telephone Number, and Relationship to Applicant
Example: Dr. Jane Doe, Assistant Professor, 555 Campus Hall., (716) 555-5555, Instructor for BIO200.
Your answer
Reference #2: Please list their Name, Title, Address, Telephone Number, and Relationship to Applicant
Example: Dr. Jenny Doe, Associate Professor, 555 Campus Hall, (716) 555-5555, Instructor for EE350.
Your answer
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