Please complete the form below and click submit when finished.

Faculty Member: *

Rank:

College: *

Department: *

Campus Address : *

Email: *

Phone: *(e.g., 8659742101)

Mark ONE of the following categories to indicate nature of the project:

The project involves research in a science laboratory.

The project involves research in applied mathematics, or mathematical/computer modeling.

Please provide a detailed description of the project and describe how a student might be involved:*

Please indicate which terms you are willing to host student(s) in your laboratory:

Summer     Fall     Spring     Academic Year (Fall & Spring)     Year-round

How many students are you willing to host each term? Indicate number in box by each term (numbers 0-9):

Summer     Fall     Spring     Academic Year (Fall & Spring)     Year-round

How many hours do you expect students to work in your laboratory each term?

(Note: Students may register for 1 credit hour per term for a research experience. Because they are enrolled in high school, their availability is Monday through Friday after 2:45 p.m., on Saturdays, or in the summer.)

Students will be required to enroll in a course and some scholarships are available. Does your research grant provide for tuition/fee payment of high school students working in your laboratory?

      Yes       No

If yes, please include account name and number below:

Account Name:

Account Number: