Friday Harbor Laboratories

Blinks-REU-BEACON Application Form for Summer 2016

First Name (given name)
Middle name or initial
Last name (family name)
Former Name (if not applicable leave blank )
Nickname (how you would be preferred to be called )
Current Mailing Address:
Street & Number
Permanent Mailing Address:
Street & Number
Contact Phone, Area Code and Number
Email address
Alternate Email address
Country of Citizenship
Country of Residence
If you are not a U.S. citizen and have a visa, what kind is it? Leave black if not applicable.
(If you are accepted to a course at FHL, we will assist you to obtain the necessary documents to enter the U.S.)
Birthdate. Required by University of Washington for registration. Information will remain secure.
Gender (used only to assign housing) Male Female
Are you currently a resident of Washington State? Yes No
If "yes" list date Washington residency began
University of Washington Student Number (if applicable):
What will be your ACADEMIC STATUS in autumn of the next school year?
Current college or university, if matriculated (EXAMPLE: Univ. of Washington) or if not currently matriculated, list the institution last attended including the degree and date (EXAMPLE: Univ. of Washington (BS 6/02)
Field of Study or Degree with Major
In the box to the right, please list all colleges you have previously attended. List most recent first. Include dates and degrees, if any. Please include any courses or research apprenticeships you have previously attended at UW-Friday Harbor Laboratories including term and year. (Please be brief; do not exceed 600 characters, or approximately 75 words.)
Select Project Choices
Please select 1-3 projects which interest you. You must e-mail a 1-page statement for each project you wish to apply for. By applying for more than one project, you increase your likelihood of being accepted.
Choice #1
Choice #2
Choice #3
OPTIONAL: Please indicate your race or ethnicity.
To help us better track our advertising efforts, please tell us briefly how you learned about our REU program:
By submitting this form, I certify that the above information is complete and accurate. I acknowledge that failure to disclose complete and accurate information may result in denial of admission or dismissal from the University. I acknowledge that physical injury and death are risks inherent in the use of these facilities, and I assume all associated risks and I agree not to claim against the University for those risks. I agree to hold the University of Washington harmless from any and all injuries, damages and liabilities that may occur in the course of my visit, except for negligent acts or omissions of the University or its employees, students or agents acting in the scope of their duties.
The University of Washington reaffirms its policy of equal opportunity in education regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam era veteran in accordance with University policy and applicable federal and state statutes and regulations.