Application Form

Research Experiences for Undergraduates in Distributed Rational Agents

Summer 2004



A. Personal Information:

1. Name: ______________________________

2. Social Security No.: _______________________

3. Date of Birth: ________________________

4. U.S. Citizen/Permanent Resident: Yes No

5. Home Address:

_______________________________________________________________________________

_______________________________________________________________________________

6. School Name and Address (include E-mail, if any):

_______________________________________________________________________________

_______________________________________________________________________________

7. Telephone numbers: Home: ______________________

School: _________________________

8. Names of Refereneces:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________




B. Academic Background:

1. Current cumulative GPA: _______________

2. Major: ________________________________________

3. Number of credit hours completed: _______

4. Classification in Fall 2004 semester: Sophomore Junior Senior

5. Academic and Extra-Curricular Accomplishments (including awards, prizes, scholarships):

____________________________________________________________________________________________

____________________________________________________________________________________________

6. Briefly explain any team work or group project you have been involved with:

____________________________________________________________________________________________

____________________________________________________________________________________________

7. Computer Systems, Programming Languages, and Operating Systems Experience:

____________________________________________________________________________________________

____________________________________________________________________________________________




C. General:

1. Career Goals: ____________________________________________________________________________

____________________________________________________________________________________________

2. Memberships in clubs, groups, and societies:

____________________________________________________________________________________________

3. Please indicate any additional information which you consider to be helpful for your application:

____________________________________________________________________________________________

____________________________________________________________________________________________

________________________________________

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