HSI STEM

Winter Research Experience

Deadline for student application submission for Winter Research Experience 2017 is Friday, Oct 28th, 2016.

The complete application form submission must include:

• HSI-STEM Winter Research Experience Online Application
• Unofficial Transcripts from all schools attended
• A Personal Statement(500 words)
  • Describe the top 3 reasons/ motivations for selecting a major in STEM? (i.e. educational experience, family, upbringing, etc.)
  • What are your short and long term career goals?
  • How might the HSI STEM Winter Research Experience help you reach your goals?
  • What do you hope to gain from your participation?
• One (1) recommendation letter from a professor, lab instructors, or STEM program director. Letter must be emailed directly to hsi-stem@csulb.edu by October 28, 2016.

Personal Information

Last Name *

First Name *

CSULB ID# *

Street Address *

City *

State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Zip *

Date of Birth (MM/DD/YYYY) *

Cell phone *

Email Address *

How did you hear about us? (check all that apply)

Fliers/Posters

Course Instructor

Bridge Alumni

Academic Advisor

Class Visit

Other

If other, please explain

Demographic Information

Age *

Sex * Male Female

Country of Birth * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d‘Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe

Race/Ethnicity (Check all that apply) *

Native American

Asian

Black/African American

Latino/Hispanic

Middle Eastern

Pacific Islander

White Caucasian

Other

If other, please explain

Are you first generation-educated? *

Yes

No

Are you Bilingual (English/Spanish) *

Yes

No

Academic Information

Department *

College of Engineering

College of Natural Science and Mathematics

What Department in College of Engineering? * Chemical Engineering Civil Engineering & Construction Engineering Management Computer Engineering & Computer Science Electrical Engineering & Biomedical Engineering Mechanical & Aerospace Engineering

What department in College of Natural Sciences & Mathematics * Biological Sciences Chemistry & Biochemistry Geological Sciences Mathematics and Statistics Physics and Astronomy Science Education Environmental Science and Policy

Declared major *

Declared Minor

Projected month/year of graduation

Month * January February March April May June July Option 8 September October November December

Year * 2016 2017 2018 2019 2020

Cumulative GPA *

Major GPA *

Number of units completed *

Did you have previous research experience (outside of courses)? *

Yes

No

Institutions Attended (Please list all universities, colleges, and community colleges)

Institutions

Dates attended

GPA

Institutions

Dates attended

GPA

Institutions

Dates Attended

GPA

Preferred Research Experience

Do you have a specific professor with whom you would like to participate in research with? *

Yes

No

If yes, please provide their information below.

Name

Department

Research Topic

Would they be willing to host you in their lab for this program?

Yes

No

If no, please list the names and departments of 3 faculty you would be interested to be paired with for the program. ** Does not guarantee you will be paired with one of the faculty you have listed below.

Name #1

Department #1

Name #2

Department #2

Name #3

Department #3

Please indicate which research lab experience you prefer. (Select all that apply) *

Field lab experience involving outdoor data/material collection, as well as working inside the lab running analysis on the data/materials collected

Lab experience involving primarily computational and/or computer based lab experiments

Lab experience focusing primarily on carrying out experiments inside a lab

Engineering/technology lab experience involving research development, design, integration, and/or analysis of new products/methods using engineering principals

No preference; I am comfortable in any research setting

References

Please provide one reference (must be a faculty or lab instructor).

Reference

Name of Reference *

Department *

Course taken with this Instructor *

Phone *

Email Address *

Grade Received *

Upload Unofficial Transcripts *

Uploading Files. Please Wait.

Documents only accepted in PDF or Word format.

Upload Resume *

Documents only accepted in PDF or Word format.

A Personal Statement (500 words) Include the following:

• Describe the top 3 reasons/ motivations for selecting a major in STEM? (i.e. educational experience, family, upbringing, etc.)
• What are your short and long term career goals?
• How might the HSI STEM Winter Research Experience help you reach your goals?
• What do you hope to gain from your participation?

Upload Personal Statement *

Documents only accepted in PDF or Word format.

I hereby certify that the information contained in this application is true and correct to the best of my knowledge. I authorize any reference, as well as all other individuals whom the HSI STEM office contacts, to provide the HSI STEM office any and all information concerning my previous experiences. *

By checking this box and typing my name below, I am electronically signing my application

First Name *

MI

Last Name *