Who are you?
           Your First Name: 
          Your Middle Name: 
            Your last Name: 

Where do you Learn?
               Your School:


Where do you live when you are at school?
    School Address Line #1: 
    School Address Line #2: 
    School Address Line #3: 
              School Phone:  


Where do you live when you are at home?
      Home Address Line #1: 
      Home Address Line #2: 
      Home Address Line #3: 
                Home Phone: 


Your E-Locations?

                    E-Mail: 
                  Web page: 

Who will write a letter of recommendation for you?

Some optional information which we are required to track, since this is a federally funded program. You are not obligated to answer these questions:

Are you a U.S. Citizen Permanent Resident non-U.S.Citizen ?

If not a U.S. citizen or permanent resident, please list country of citizenship:

(Due to NSF regulations, only U.S. citizens and permanent residents can receive stipends, housing and travel support.)

Some details

List of this semester's classes with an estimate of your grades:



Courses, employment, or other experience relevant to the REU program (advanced courses in math, CS, engineering, etc.; specifically, mention which programming languages/packages you are familiar with, such as C, C++, Maple, MAGMA, GAP, Mathematica, etc.):



Is it possible for you to continue this project at your home institution during the 2004-2005 academic year? (This is strongly encouraged.)

Yes

Probably

Maybe

Probably Not

No

Please Explain:

Do you wish to be considered for the visit to DIMACS' sister site, DIMATIA, in Prague? Yes No

Please consult the DIMACS AND Math Department webpages and list below the project numbers (e.g. DIMACS 2005-01, Math 2005-06) in order of preference (please list all that are of interest to you).

     1: 
     2: 
     3: 
     4: 
     5: 
     6: 
     7: 
     8: 
     9: 
     10:
     11:
     12:
     

Do you have any comments or questions?