NATIONAL RADIO ASTRONOMY OBSERVATORY

Summer Student Program Director

520 Edgemont Road

Charlottesville, VA 22903-2475

Telephone: (434) 296-0225

APPLICATION FOR SUMMER STUDENT PROGRAM

THE DEADLINE FOR RECEIPT OF THIS APPLICATION AND SUPPORTING

MATERIAL IS JANUARY 25

Do Not Fax Application Form, Letter of Interest, or Transcripts

1. NAME: SOCIAL SECURITY NO.:

LAST	FIRST	MIDDLE

2. MAILING ADDRESS ON MARCH 15:

STREET ADDRESS	(PLEASE INDICATE IF THIS ADDRESS IS A UNIVERSITY ADDRESS □ )

TELEPHONE:

CITY	STATE	ZIP CODE

3. HOME ADDRESS:

STREET ADDRESS

TELEPHONE:

CITY	STATE	ZIP CODE

4. E-MAIL ADDRESS: WEB PAGE URL:

5. IF YOU ARE NOT A U.S. CITIZEN, PLEASE INDICATE VISA STATUS: Immigrant □ ; F-1 Student □ ; Other

6. TRANSCRIPTS: The applicant should arrange for official transcripts to be sent from the institutions listed below. A list of courses now in progress should also be sent.

COLLEGE OR UNIVERSITY	MAJOR SUBJECT	DATES ATTENDED

FROM TO	DEGREE	DATE DEGREE

RECEIVED OR EXPECTED

Please circle present academic level: 1 2 3 4 5 Year - Undergraduate	1 2 Year - Graduate

7. RECOMMENDATIONS:	Please list three or four people who can evaluate your ability, experience, and potential. The applicant should arrange for the letters of recommendation to be sent directly to the NRAO address above.

NAME	COLLEGE OR UNIVERSITY	DEPARTMENT	EMAIL ADDRESS	AREA CODE -- TELEPHONE NUMBER

8. DATES YOU WOULD BE AVAILABLE FOR THE PROGRAM: FROM TO

9. PLEASE INDICATE IF YOU WOULD BE ACCOMPANIED TO NRAO BY SPOUSE OR DEPENDENTS:

10. PLEASE INDICATE YOU PREFERENCE FOR TYPE OF WORK, MARKING 1, 2, AND 3:

ASTRONOMY	COMPUTING	ELECTRONICS

11. ALTHOUGH COMPUTER EXPERIENCE IS NOT NECESSARY FOR SOME ASSIGNMENTS, PLEASE INDICATE YOUR PROGRAMMING ABILITY BELOW:

MACHINE	LANGUAGE	MONTHS EXPERIENCE	SHORT DESCRIPTION OF PROJECT

12. PLEASE LIST ANY SCIENTIFIC OR RELATED EMPLOYMENT, INCLUDING ASSISTANTSHIPS, WHICH YOU HAVE HAD SINCE GRADUATION FROM

HIGH SCHOOL:

DATES

FROM TO	EMPLOYER'S NAME AND ADDRESS	JOB TITLE	SHORT DESCRIPTION OF MAJOR DUTIES

13. PUBLICATIONS AND HONORS:

14. LETTER:	An important part of this application is a letter in which you should describe your educational background and goals, and your scientific interest and experience. The letter should contain whatever further information that you consider relevant to the evaluation of your potential for success as a research assistant in the NRAO Summer Student Program. Please submit the letter together with this application form.

NOTE: Summer students at NRAO must sign a patent agreement.

SIGNATURE	DATE

(Revised: 07/01)