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A. James Clark School of Engineering
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Application for REU and IRES Summer 2021
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Name
First Name
*
Last Name
*
Current Address
Current Street Address
*
Current City
*
Current State
*
Current Zip Code
*
Is your current address the same as your permanent address?
*
Yes
No
Permanent Address
Permanent Street Address
Permanent City
Permanent State
Permanent Zip
Is your permanent address within 30 miles of the University of Maryland College Park campus?
*
Yes
No
Contact Information
Cell Phone
*
Permanent Phone
*
Email Address
*
Other Personal Information
Citizenship
*
US Citizen
Permanent Resident
If you are neither, you are not eligible
Permanent Resident Information
What is the Country of your Citizenship?
Alien Registration#
Are you of Hispanic origin?
*
Yes
No
Race/Ethnicity
African American/Black
Asian
Caucasian/White
Latino
American Indian/Alaskan Native
Other
I do not wish to disclose this information
For statistical purposes only
Please specify
Gender
Male
Female
I do not wish to disclose this information
How did you hear about this program?
*
Former Participant
NSF REU Website
REU Flyer
Faculty Advisor
Email
Other
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