Student Travel Award Application

Advances & Opportunities at the Biology/Math/Computation/Physical Sciences Interface

March 6-7, 1999

Travel funds are available to encourage participation by undergraduate and graduate students. We particularly encourage women and minorities to apply.

YOU MUST REGISTER FOR THE WORKSHOP BEFORE YOU APPLY FOR A TRAVEL AWARD. APPLICATIONS WILL NOT BE PROCESSED UNLESS WE HAVE RECEIVED YOUR REGISTRATION FORM FIRST.

Please apply by completing the following entries. When finished, press the "submit" button at the bottom of the form.

A recommendation in support of your application is also required for award of a travel fellowship. This should come from your supervisor (if you are a graduate student or are carrying out undergraduate research) or a professor in your major area who knows your work. This information can be sent by regular mail, e-mail, or FAX to:

Rutgers, The State University of New Jersey
Wright-Rieman Labs
610 Taylor Road
Piscataway, NJ 08854-8087
Attn: Sarah Kozak

Email: kozak@rutchem.rutgers.edu
FAX:(732) 445-1493
Phone: (732) 445-6376
Note that your application will only be complete after we receive these two items from you: (1) a completed application form [via this electronic submission], and (2) a confidential letter of recommendation.


Travel Fellowship applications must be received by February 2, 1999. We will notify applicants of our decision by mid-February.


Who are you?       
           Your First Name: 
            Your last Name: 
        Your email address: 

Citizenship? Are you a U.S. citizen or permanent resident?: If yes, please enter social security number: If not a U.S. citizen or permanent resident enter country of citizenship:
Where do you study?

School: Major: What are your scientific/mathematical interests and what benefits would you derive from attending this meeting? Expected degree and graduation dates: Current GPA:


Hotel Accommodations? *** NOTE: ALL ROOMS ARE NON-SMOKING *** Will you need a room at the University Inn and Conference Center? Name of preferred roommate who will also be attending the workshop:
Who will write a letter of recommendation for you? Name and Title:
Demographics? We are required to track the following information because we receive federal funding. You are not required to answer these questions, but your input would be helpful: Birthdate: Gender: Ethnicity:
Courses, employment, or other experience relevant to the workshop (advanced courses in math, computer science, engineering, chemistry, biology, physics, etc.; specifically, mention prior lab experience, programming languages, fellowships, awards, internships, etc.):



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