Application for 2009
"Undergraduate Research Program"
in the Department of Chemistry at Lehigh University

Please submit a copy of your college transcript.  Unofficial copies are acceptable.

Please send a short resume and two letters of recommendation. Emailed recommendations are acceptable.

All application materials must be received by March 15, 2009.

Please type in your information to complete this form.

If you prefer to download a form, please email chemgrad@lehigh.edu

Summer Research Applications
Department of Chemistry
6 E. Packer Ave.
Lehigh University, Bethlehem, PA 18015-3172

Direct any questions to JoAnn DeSalvatore at chemgrad@lehigh.edu or 610-758-3471

Name :	First  Last
Phone Number :
*Email Address :
Name of University :
Current address (where you live now):
Home address (where you live when you’re not on campus):
Lehigh University is an equal opportunity/affirmative action employer. In an effort to help us abide by these principles, we ask that you answer the following optional questions regarding race and gender.
Check all the boxes that apply to you:
Racial Heritage: :	Black  White American Indian Hispanic  Asian Other
Please indicate your gender: Female Male
Are you a citizen or permanent resident of the United States? (If so check box)
Country of residence:
Major/Minor :
Current GPA :
Academic Status :	Freshman Sophomore Junior Senior
Expected Graduation Date :
Areas of Interest :	Organic Chemistry Inorganic Chemistry Polymer Chemistry Biochemistry Analytical Chemistry Scientific Writing
Chemistry courses completed as of summer 2008 (Check all that apply) :
	General Chem Analytical Chem Organic Chem Physical Chem Inorganic Chem Instrumental Analysis Biochemistry Polymer Chem   Additional Courses :
Honors or Awards :
Research Interests :
Previous Research-Related Activities :
Please provide the name, email, and phone number of two (2) current professors or research advisors familiar with you and your work :
Reference 1 :
Name :	First  Last
Phone Number :
Email Address :
Reference 2 :
Name :	First  Last
Phone Number :
Email Address :
Will local housing be needed?  Yes  No

* required information