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: -- Select a State/Province -- Alabama (AL) Alaska (AK) American Samoa (AS) Arizona (AZ) Arkansas (AR) California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) District of Columbia (DC) Federated States of Micronesia (FM) Florida (FL) Georgia (GA) Guam (GU) Hawaii (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME) Marshall Islands (MH) Maryland (MD) Massachusetts (MA) Michigan (MI) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Northern Mariana Islands (MP) Ohio (OH) Oklahoma (OK) Oregon (OR) Palau (PW) Pennsylvania (PA) Puerto Rico (PR) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virgin Islands (VI) Virginia (VA) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY) Armed Forces Africa (AE) Armed Forces Americas (AA) Armed Forces Canada (AE) Armed Forces Europe (AE) Armed Forces Middle East (AE) Armed Forces Pacific (AP) Alberta (AB) British Columbia (BC) Manitoba (MB) New Brunswick (NB) Newfoundland and Labrador (NL) Nova Scotia (NS) Northwest Territories (NT) Nunavut (NU) Ontario (ON) Prince Edward Island (PE) Quebec (QC) Saskatchewan (SK) Yukon (YT) Other *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 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2020 2021 2022 2023 2024 2025 2026 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: General Data Protection Regulation I agree to Pepperdine's communication and GDPR consent? Yes No