APPLICATION for Research Experiences for Undergraduates: Summer 2020 (Thailand)

Name

Email Address

Statement of Intent

Institution and Major (Minor):

Year/Level (GPA):

Reference 1: (Name,_Institution,_Email,_Telephone)

Reference 2: (Name,_Institution,_Email,_Telephone)

Reference 3: (Name, Institution, Email, Telephone)

Contact Information: (phone, mailing address)

U.S. Citizen or Permanent Resident (Yes or No)

Gender: Male or Female (optional)

Race/Ethnicity: Native American, Hispanic/Latino/Chicano, African-American, White, BiRacial (optional)

Legal Name as on Passport:

confirm email:

confirm phone: