| 1. Full Legal Name |
| Last Name |
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| First Name |
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| Middle Name |
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| 2. Citizenship |
| Permanent Resident Status |
Yes
No |
| Number: |
A- |
| Date Issued: |
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| Country of Citizenship: |
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| Country of Birth: |
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| 3. Current Mailing Address |
| Number and Street or P.O. Box 1 |
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| Number and Street or P.O. Box 2 |
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| City: |
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| State: |
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| Zip Code: |
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| Area Code & Telephone Number: |
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| Area Code & Work Telephone Number: |
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| 4. Permanent Mailing Address (if different from Current Address) |
| Number and Street or P.O. Box 1 |
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| Number and Street or P.O. Box 2 |
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| City: |
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| State: |
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| Zip Code: |
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| Area Code & Home Telephone Number: |
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| 5. E-Mail |
| Primary E-Mail Address: |
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| Secondary E-Mail: |
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| 6. Education Information |
| Current Institution: |
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| Major(s): |
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| Minor(s): |
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| Cumulative GPA: |
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| Major GPA: |
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| Total Credit Hours (June 2008): |
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| Expected Date of Graduation: |
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| Current Undergraduate Academic Standing (Year): |
2nd3rd4th |
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| 7. Current Coursework |
| List all courses you are currently taking: |
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| 8. Research Interests |
| In which fields of research are you most interested? |
| Primary: |
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| Secondary: |
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| 9. Employment History |
| Please list your employment experience, starting with
current or most recent |
| position first; include summer and part-time work. |
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| 10. Computer Background |
| Please list your computer experience (programs, programming): |
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| NOTE: This question is for informational purposes only. It
will NOT be used to determine eligibility. |
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| 11. Academic and/or Professional Affiliations |
| Please list all honors, scholarships, academic and/or
professional memberships and extracurricular activities: |
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| 12. How did you hear about the RESESS program? |
|
RESESS
web site Conference,
please specify
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Publication,
please specify
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RESESS
recommended to me by
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| 13. Transcripts |
| The RESESS Program requires certified/official
copies of college/university transcripts. Please request |
| transcripts from all colleges and/or universities you have
attended. Contact your college/university |
| Registrar's Office for your certified/official
transcripts. Transcripts should be sent to: |
| |
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| 14. Letters of Recommendations |
| The RESESS Program requires two (2) Letter of Recommendation Forms from people that can comment on your ability to succeed in an academic or research setting and at least ONE who has observed your work in these areas.
Transcripts and Letters of Recommendation should be sent to: |
| |
|
| Dr. Susan Eriksson, RESESS Director |
| UNAVCO, Inc. |
| 6350 Nautilus Dr. |
| Boulder, CO 80301-5554 |
| |
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| 15. Authorization |
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I hereby certify to the best of my knowledge that the information furnished on this application is true and complete without evasion or misrepresentation. I understand that if found to be otherwise, it is sufficient cause for rejection or dismissal.
Yes
No
Date: |
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Personal Essays |
| 1. What do you hope to gain from participating in RESESS,
and how will participating in the program help you |
| to achieve your academic and career goals? (100 words) |
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| 2. RESESS is dedicated to enhancing diversity of future
scientific communities by increasing the number of |
| students from historically underrepresented groups who
enroll and succeed in master's and doctoral degree |
| programs in the solid earth geosciences. |
| |
| Describe how your participation in RESESS will contribute
to this mission. (100 words) |
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| 3. Please describe your academic plans, career interests
and objectives, community involvement, significant |
| events/experiences that have influenced your life, or any
other information you believe would assist the |
| RESESS in its evaluation of your application. (1 to 2
typed pages) |
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