Name: (Please input as: Last Name, First Name, Middle Initial);
   

College or University: 

Home Phone:      School Phone: 

E-Mail: (Required)

Anticipated Graduation Date: May-June Dec-Jan Other 2009 2010 2011 2012 2013
(preference given to those graduating between Dec. 2009 and Dec. 2009)

Mailing Address and Phone valid in March and April:

Dates of your Spring Break: 

Mailing Address and Phone where you can be contacted during Spring Break:

Please check which of the following courses you have had and indicate the text used.
Also list all other mathematics and computer science courses past Calculus that you have taken.

Real Analysis or Advanced Calculus: No Yes 
  Text:

Linear Algebra: No Yes   Text:

Complex Analysis: No Yes   Text:

Abstract Algebra: No Yes   Text:

Probability: No Yes   Text:

Graph_Theory or Combinatorics: No Yes 
  Text:

Other courses and texts:

GPA in Math/CS Courses       

Overall GPA 

(Optional) Check any of the following groups to which you belong.
African American  Asian American European American Hispanic  Native Alaskan  Native American Native Pacific Islander  Other Decline to answer

Have you participated in another summer REU or undergraduate research program?  No  Yes 

If your answer is yes, please describe the program.

Are there any awards or honors that you have received, or anything else that you want to tell us?

Please list in the space below, the names, institutions, phone numbers and e-mail addresses of the faculty that you are asking to write letters of recommendation.

Reference 1:

Reference 2: 

My permanent mailing address is:

I certify that, to the best of my knowledge, all the information I have given as part of my application is accurate and that I am a U.S. citizen or permanent resident.

When you are finished completing this form, press the submit button below. Don't forget to check the instructions for other requirements for applying to the program.

There have been occasional problems with this form being submitted automatically.
If you do not get confirmation that the submission occurred within a few dys after you hit the SUBMIT button below, please let me know. (garity at math dot oregonstate dot edu)