Research Experiences for Undergraduates in Information Processing and Decision Making for Intelligent and Secure Environments Application Form - CSE@UTA - Summer 2009 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)*: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 7. School Name and Address (include E-mail, if any)*: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 8. Telephone numbers*: Home: _________________________ School: _________________________ 9. Names of Refereneces*: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ B. Academic Background (items marked with * are required): 1. Current cumulative GPA*: _______________ 2. Major*: ________________________________________ 3. Number of credit hours completed*: _______ 4. Classification in Fall 2009 semester* (check one): 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: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________