Application Form

Research Experiences for Undergraduates In Mathematics At California State University, San Bernardino

Name:__________________________________________

Address:________________________________________

_______________________________________________

Telephone Number:________________________________

Email:__________________________________________

College attending:_________________________________

Class Level:_____________________________________

Citizenship Status:_________________________________

Circle any of the groups to which you belong (OPTIONAL):

Women / Hispanic / African American / Native American /

Native Alaskan / Native Pacific Islander / Disabled / Other:_______

List the names and addresses of the two faculty that you have asked for references.

Describe your academic interests.

List the mathematics and computer science courses that you have taken or are currently enrolled in. Indicate the grade you earned in the courses already completed.

Describe any independent study or research projects in which you have been involved.

What are your long-term career plans?

Additional Remarks:

Please return this form along with transcripts (unofficial are OK) by February 28, 2006 to:

    Rolland Trapp

    Department of Mathematics

    California State University

    5500 University parkway

    San Bernardino CA 92407