WHOI Summer Student Fellowship Application Form

Title:
First Name (Given):
Middle Initial:
Last Name (Surname):
 
Address for Reply:
Address 1:
Address 2:
Address 3:
Address 4:
City:
State:
Postal Code:
Country:
Phone Number: Email Address:
 
Home (legal) Address:   Same as above
Home Address 1:
Home Address 2:
Home Address 3:
Home Address 4:
Home City:
Home State:
Home Postal Code:
Home Country:
Home Phone Number:
 
Are you a U.S. citizen?
Yes  No   If NO, Citizen of what country? What type of visa do you hold, if any?
 
 
 
Do you have a U.S. Social Security Number?:
Yes   No  
 
 

Record of Education

Most Recent Undergraduate University:
University Name:
Number of Years Completed:
Date Attended From:

format: yyyy/mm
City:
State:
Date Attended To:

format: yyyy/mm
Major/Field:
Name of Degree/Diploma:
Date Degree Granted/Expected:

format: yyyy/mm
 
Other Undergraduate University:
University Name:
Number of Years Completed:
Date Attended From:

format: yyyy/mm
City:
State:
Date Attended To:

format: yyyy/mm
Major/Field:
Name of Degree/Diploma:
Date Degree Granted/Expected:

format: yyyy/mm
 
Most Recent High School:* transcript is optional
School Name:
Number of Years Completed:
City:
State:
Date Attended From:

format: yyyy/mm
Date Attended To:

format: yyyy/mm
 
 
Other Licenses and Certifications:
Honors and Awards:
 
Have you applied to the Summer Student/Minority Fellowship program in the past?
No  Yes  If YES, When?
 
Have you been affiliated with WHOI in the past?
No  Yes  If YES, How and when?
 
 
If any member of your family or household is associated with WHOI, please state name and relationship:
 
Have you previously attended another Research Experience for Undergraduates program?:
No  Yes  
Where did you hear about this program?
Poster
Professor/Advisor/School Department
WHOI Website
Friends
Former program participant/JP Student
Other Website
Magazines   please specify 
Other   please specify 
 
 
If you have a scientific sponsor on the WHOI staff in mind, please indicate who:
 
Sponsor's Name:
Have you contacted this person?
No  Yes
Sponsor's Name:
Have you contacted this person?
No  Yes
Sponsor's Name:
Have you contacted this person?
No  Yes
Sponsor's Name:
Have you contacted this person?
No  Yes
 
 
Please specify here any additional information that you are unable to include due to the application constraints:
 
 

References

Please have at least three people who can evaluate your academic performance complete and return the evaluation forms. In addition, list them with their information in sections A, B, and C. Feel free to list additional references, if you like, in sections D and E. Do not use relatives. Relatives of WHOI employees may not use other WHOI employees as references.
 

A

Title:
First Name:
Last Name:
Occupation:
University/College Affiliation:
Email:
Phone:
 
 

B

Title:
First Name:
Last Name:
Occupation:
University/College Affiliation:
Email:
Phone:
 
 

C

Title:
First Name:
Last Name:
Occupation:
University/College Affiliation:
Email:
Phone:
 
 

D

Title:
First Name:
Last Name:
Occupation:
University/College Affiliation:
Email:
Phone:
 
 

E

Title:
First Name:
Last Name:
Occupation:
University/College Affiliation:
Email:
Phone: