Research Experiences for Undergraduates in Information Processing and Decision Making for Intelligent and Secure Environments

Application Form - CSE@UTA - Summer 2007

A. Personal Information (items marked with * are required):

1. Name*: ______________________________

2. Social Security No.*: _______________________

3. Date of Birth*: ________________________

4. Citizenship* (check one): U.S. Citizen____ Permanent Resident____ Other____

5. Demographic Information:

a) Gender: Female____ Male____

b) Ethnicity/Race: Hispanic / Latino____ American Indian / Alaskan Native____

Asian____ Black / African American____

Native Hawaiian / Pacific Islander____ White____

6. Home Address (include E-mail, if any)*:

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

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8. Telephone numbers*:

Home: _________________________ School: _________________________

9. Names of Refereneces*:

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B. Academic Background (items marked with * are required):

1. Current cumulative GPA*: _______________

2. Major*: ________________________________________

3. Number of credit hours completed*: _______

4. Classification in Fall 2007 semester* (check one): Sophomore____ Junior____ Senior_____

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

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

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

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C. General:

1. Career Goals: ____________________________________________________________________________

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2. Memberships in clubs, groups, and societies:

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

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