Internship Program Eligibility Application About John Glenn About Louis Stokes Frequently Asked Questions
 

2009 GLENN-STOKES
SUMMER RESEARCH INTERNSHIP APPLICATION

Before completing this form, please make sure you review the list of items you will need
to successfully complete the application.
Areas marked with an asterisk (*) are required fields.

PERSONAL DATA
First Name:*
Middle Name:
Last Name:*
   
Mailing Address:*
 
City:*
State:
Zip:*
Phone: xxx-xxx-xxxx
E-Mail:*
   
Permanent Address:
 
City:
State:
Zip:
   
Institution currently attending:*
Department or Major: *
Expected Graduation:*  
GPA:* x.xx      
Class Rank: First Year Sophomore Junior Senior
Gender:* Male Female
Race:* African American Asian American Pacific Islander
Native American   White
  Other ( )
Ethnicity:* Hispanic Non Hispanic
     
Citizenship: Permanent Resident?
(Green Card Holder)
US Citizen?

Ohio Resident?
 
PARTICIPATION IN STEM SUPPORTED PROGRAMS
Have you previously participated in an academic year or summer research internship? Yes No
If so, please specify the the year(s) you participated in each program.
   
Program Year(s)
Glenn-Stokes
McNair
STARS
SROP
REU/NIH Supplement
Other (include program
and year)  
   
RECOMMENDATIONS
Please give the complete name, address and phone information for two faculty members whom you have asked to write a recommendation for you:
   
Faculty Member #1  
Faculty Rank:
First Name:* Last:*
Institution:*
Discipline:
Campus Address:
 
City
State
Zip:
Campus Phone: xxx-xxx-xxxx
E-Mail:*
   
Faculty Member #2  
Faculty Rank:
First Name:* Last:*
Insititution:*
Discipline:
Campus Address:
 
City:
State:
Zip:
Campus Phone: xxx-xxx-xxxx
E-Mail:*
  
RESEARCH INTERESTS (Instructions)
Describe the research areas that interest you.
   
PROPOSED FACULTY RESEARCH MENTOR
If you have a preference for working with a specific faculty mentor, please complete the information below. Campus representatives will match students with faculty mentors if you do not indicate a preference. Choice of mentor is subject to approval by the Alliance Campus Representative.
   
Title:
First Name Last
Insititution:
Discipline:
Address:
 
City:
State:
Zip:
Campus Phone:
E-Mail:
RESEARCH LOCATION
If you have a preference, please indicate the institution(s) in which you would like to participate as a Glenn-Stokes Summer Research Intern:
To select multiple institutions, PC users hold down the CTRL button and Mac users hold down the apple while making selections with your mouse.
 
 
   
 
For more information, contact the Ohio Science and Engineering Alliance at 614.247.7267
Updated 1.06.09