application by HU30t88


									                                         NSF S-STEM
                    Application Form: Deadline 5:00PM, June 14, 2013

Name: __________________________________ Email address: ____________________
       Last        First        Middle

High School:____________________         Community College ________________________

Permanent Mailing address:       ________________________________________________
                                 Street address

                                 _________________, ____________           ____________
                                 City                State                 Zip Code

Telephone numbers: _____________________, ______________________

Ethnicity (circle one or more): African American, Asian American, American Indian, Hispanic
                           White, Other (please specify) ____________

Sex (circle one): Female, Male

Check: US Citizen ______________                   Permanent Resident _______________
Please provide a statement of your interest and a description of career objectives in the
following space:

All of the following required application materials must be received by the deadline. Electronic
application and recommendations encouraged.
  - this application form
  - one email recommendations

All application materials must be received by 5 PM, Friday, June 14, 2013. Send all materials either
by email to or by mail to:
                    Dr. David Schaefer
                    Department of Physics, Astronomy, and Geosciences
                    Towson University
                    7800 York Rd
                    Towson, MD 21252

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