SAMSI Two-Day Undergraduate Workshop Application: February 26-27, 2010

19 T.W. Alexander Drive
P.O.Box 14006
Research Triangle Park, NC 27709-4006
Tel: 919.685.9350
Fax: 919.685.9360
info@samsi.info

SAMSI TWO-DAY UNDERGRADUATE WORKSHOP

February 26-27, 2010

Application

To apply to attend the workshop, please fill out the form below, and then click the SUBMIT APPLICATION button. All items are required. Following submission, a confirmation of your application will be displayed: print a copy for your records.

Applications will be considered beginning November 19, 2009 and continuing until all participant openings are filled. Registrations before January 22, 2010 will be given full consideration. Upon acceptance for the program, individuals must confirm by e-mail within three days their intention to participate and also provide details of their travel plans (otherwise their registration will be cancelled and their place given to another applicant).

Please send questions to ugworkshop201002@samsi.info.

Applicant Information

First Name Last Name

Address

City State Zip Code

Telephone (Format: xxx-yyy-zzzz)

E-mail

College or University

Major

Year GPA

Visa Status (please select one)

US Citizen
US Permanent Resident (Green Card Holder)
Visa Holder

Statement of Interest

Please provide a brief statement (at most one page) on why you wish to attend the workshop. You may cut and paste text from another application you wish.

Submission

By submitting this application you agree that:

If you are accepted, you will confirm by e-mail within three days your intention to participate and also provide SAMSI details of your travel plans.
If you are a confirmed registrant who does not subsequently attend the workshop and does not cancel your registration with SAMSI at least seven days prior to the workshop, you may be billed for your hotel room.

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