| Last Name | |
| First Name, MI | |
| Email Address: | |
| Address (Street, City, State, Zip) | |
| Telephone Number (Area code + 7 digits) | |
| Undergraduate College / University | |
| Current major | |
| Current minor, if any | |
| Current year in school | Freshman
Sophomore
Junior
Senior
|
| Expected Graduation Date | |
| Overall GPA | |
| Gender | Female
Male
Do not wish to report
|
| Ethnicity | Hispanic or Latino
NOT Hispanic or Latino
Do not wish to report
|
| Race (please check all that apply) | Alaska Native
Asian
Black or African American
Native American
Native Hawaiian or Other Pacific Islander
White
Unknown
Do not wish to report
|
| Disability Status | Hearing Impairment
Visual Impairment
Mobility or Orthopedic Impairment
None
Other
Do not wish to report
|
| Are you in the military or a recent war veteran? | Yes
No
Do not wish to report
|
| Citizenship | U.S. Citizen
Permanent Resident
Temporary Resident
|
| Are you part of an LSAMP Program at your home institution? LSAMP is the NSF Funded Louis' Stokes Alliance for Minority Participation. Are you a student member of The National GEM Consortium? | Yes, LSAMP Participant
Yes, GEM Participant
No
|
| Are you a student member of any of the following student or professional organizations? | AISES
NSBE
SACNAS
SHPE
SWE
ASME
Other
|
| Previous research experience (outside laboratory courses) | None
Less than 50 hours
More than 50 hours
|
| Plans for graduate / professional degree | None
MS
PhD
MD
Other
|
| Specific area of interest in graduate / professional school (e.g. ME) | |
| Have you previously conducted research with a faculty member at another academic institution? If so, who and where and what was your research topic? | |
| Have you previously conducted research with a faculty member at the Center for Compact and Efficient Fluid Power, if so, who? | |
| Are there any other factors that should be considered when placing you in a specific laboratory or research experience? | |
| Indicate each REU location that interests you. | GATech
MSOE
NCA&T
Purdue
UIUC
U of MN
Vanderbilt
|
| Are you interested in any of the listed CCEFP research projects in particular? | |
| Please submit a one-page Statement of Purpose indicating your interest in fluid power, why you should be selected to participate in the CCEFP REU Program. | |
| Please submit a current one-page resume | |
| If it is available, please submit your official or unofficial school issued transcript. | |
| Names, titles and email addresses of your references | |
|