Research Experiences for UND Undergraduates (REFUNDU) - Summer 2012

(1) Applicant Contact Information
Name of Applicant (last, first, middle)
Mailing Address
(Street, Apt #, City, State, Zip)
Permanent Address
(If different from above)
Telephone (Home)
Telephone (Cell)
Email Address
Emergency Contact
(Name, Contact Information [including phone numbers], Relationship)
(2) Applicant Academic Information
List High School(s) and College(s) Attended
Name Location Dates Attended Degree
Current College
Current Academic Level
Expected Graduation Date (mm/yyyy)
Indicate Grade Point Average (GPA) and scores for the following (if available): GPA Overall GPA Science Only Science Hours Completed
GPA Last Semester Hours Completed Last Semester
SRA ACT SAT
When did you begin college?



Year

   
Anticipated Major Subject Area:
Academic Honors, if any:
(3) Demographic information required by the NSF
Gender (select one) :  
US Citizenship:  
Permanent Resident Alien:  
Applicants who are biracial or multiracial may check more than one designation as appropriate.





Will you be the first person in your family to graduate from college?  
   
Applicant age:  
Number of dependents:  
Dependent ages:  
     
If you have a disability and require an accommodation, please contact Dr. Van Doze (van.doze@med.und.edu), Department of Pharmacology, Physiology & Therapeutics, University of North Dakota School of Medicine & Health Sciences (701) 777-6222.
(4) Applicant Recommendations and Transcripts

List the name, address, phone number, and email address of two instructors familiar with your abilities. Ask them to send a letter of recommendation to Dr. Van A. Doze at the address below.
1:
2:

Transcripts may be issued to student or mailed directly from school. Please send letters of recommendation and transcipts to:

Dr. Van A. Doze, NSF-REU
Pharmacology, Physiology & Therapeutics
University of North Dakota School of Medicine
501 N. Columbia Rd., Rm. 5700A
Grand Forks, ND 58202-9037
Email: van.doze@med.und.edu

Application deadline and program dates can be found at www.ndinbre.org/opportunities/refundu.

Please direct your questions to Dr. Van A. Doze (van.doze@med.und.edu), Department of Pharmacology, Physiology & Therapeutics, University of North Dakota (701) 777-6222.

(5) Autobiographical Sketch

In your own words, please discuss your academic plans, noteworthy scholarly achievements, career interests and objectives, work experience, community involvement and personal interests. Please also discuss how you learned about this program and why you are interested in participating. Also indicate why you wish to pursue a career in the sciences, including teaching. Three page limit.