SURB Application

SURB 2021: June 1 - July 31

Application Deadline: February 17, 2021

Note: Fields marked with a red star (*) are required.

Name

* First Name:
*Middle Initial:
* Last Name:

Local Info

* Address:
Address 2:
* Telephone Number:
*E-mail Address:

Home Address

*Address:
Address 2:
* City:
* State:
*Zip Code:
* Country:
*Telephone Number:

College Info

*College/University:
* Your Major:
* GPA (4.0 scale):

Future Goals and Plans

What best describes your career goal(s)? Please choose Yes or No for each career.


Research Scientist	Yes	No
Science Educator	Yes	No
Environmental Science	Yes	No
Biotechnology	Yes	No
Medical / Dental Practice	Yes	No
Other	Yes	No

Do you plan to continue your studies after graduation?	Yes No
If your answer is "yes," do you plan to attend graduate school or professional school?	Graduate Professional

*What is your anticipated terminal degree?

In the Fall of this academic year, what year will you be? (NSF requires that participants be undergraduates.)	First Year Sophomore Junior Senior

List the biology courses you will have completed by this summer:


On what date do you plan to receive your undergraduate degree (month/year)?	Month Year

Additional Info

Are you a citizen or permanent resident of the United States? (NSF requirement.)	Yes No

Do you have any medical problems requiring special care?	Yes No
If so, please specify:


If you are accepted to the SURB program, can you begin on the starting date? (Program requirement.)	Yes No

Please rank your research preferences from first to last:

Animal Ecology	First	2nd	3rd	4th	5th	6th	Last
Cell Biology	First	2nd	3rd	4th	5th	6th	Last
Marine Biology	First	2nd	3rd	4th	5th	6th	Last
Mathematical Modeling of Biological Systems	First	2nd	3rd	4th	5th	6th	Last
Microbial Genomics	First	2nd	3rd	4th	5th	6th	Last
Molecular Biology	First	2nd	3rd	4th	5th	6th	Last
Plant Ecology and Physiology	First	2nd	3rd	4th	5th	6th	Last

Special Consideration

Applicants should note that this award is based on a variety of criteria. However, under NSF guidelines special consideration may be given to students who are underrepresented in science:

Hispanic or Latino
Black or African American
American Indian
Native Alaskan
Native Hawaiian or other Pacific Islander
Disabled (hearing impairment, visual impairment, mobility or orthopedic impairment)

If you would like to be considered under this NSF definition, please indicate your basis for qualification:

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I agree to Pepperdine's communication and GDPR consent?
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