application by HU30t88

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									                                         NSF S-STEM
                                          SPEeD-UP
                    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 dschaefer@towson.edu 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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