SAMSI Undergrad Workshop May 17-21, 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 UNDERGRADUATE WORKSHOP

May 17-21, 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 until April 2, 2010, or until capacity is reached. Upon acceptance for the program, individuals must confirm by e-mail within three days their intention to participate (otherwise their registration will be canceled and their place given to another applicant). Accepted participants will be advised regarding airfares and will need to purchase plane tickets with a three-week advance fare.

Please send your letters of reference and direct any questions to ugworkshop201005@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.

SAMSI Home Page

This page updated on February 16, 2010 4:05 PM