Undergraduate Summer Research Award Application

Name Name * First Last
Email *
Phone Phone * - ### - ### ####
Current Academic Status *

Current Academic Status First Year Student Second Year Student Third Year Student Fourth Year Student Other Other
Race/Ethnicity (optional)

Race/Ethnicity (optional) Alaska Native African America Asian Native America Native Pacific Islander Caucasian Hispanic/Latino Decline to Answer Other Other
Department *

Department Physics Chemistry & Biochemistry Math Other Other
Major *
Minor (if applicable)
Current Cumulative GPA *
If you feel your GPA does not accurately reflect your capabilities, please explain here.
Expected Graduation Date (month/year) *
Are you planning to attend graduate school? *

Are you planning to attend graduate school? Yes No Undecided
If yes, what area of study are you planning to pursue in graduate school?
Personal Statement
Tell us about yourself, why you would like to participate in the program and what are your career goals in 500 words or less. *
Must be between 1 and 500 words. Currently Entered: 0 words.
List any relevant college level courses and labs you have taken or are currently taking.
List any awards, honors, or other notable accomplishments.
Do you have prior research experience? *

Do you have prior research experience? Yes No
If yes, please provide a brief description of the research and any activities and/or publications
you were involved in.

Also include the institution and research advisor's name
Research Plan/Proposal
Please make certain to create this plan with your advisor's input and approval. *
Must be between 1 and 500 words. Currently Entered: 0 words.
Faculty Advisor/Endorser Information
Full Name / Department / Email Address *
Confirm that you are available to perform research on a full-time basis for 10
weeks from June 29 to September 4. *

Confirm that you are available to perform research on a full-time basis for 10
weeks from June 29 to September 4. Yes No
Confirm that you are not receiving any other support that would impact
your ability to use the summer research award.

Students should discuss potential impacts on their financial aid with a counselor at finaid@ucsd.edu, (858) 534-4480. *

Confirm that you are not receiving any other support that would impact
your ability to use the summer research award.

Students should discuss potential impacts on their financial aid with a counselor at finaid@ucsd.edu, (858) 534-4480. Yes No
Confirm that you will provide a written report of your accomplishments at the
end of the 10-week term and take part in a public poster session presenting your
research. *

Confirm that you will provide a written report of your accomplishments at the
end of the 10-week term and take part in a public poster session presenting your
research. Yes No
Upload Faculty Endorsement Letter here:

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