Application for Summer Undergraduate Research Fellowship
in Information Technology (SURF-IT)

Personal Information
First name:
Middle name:
Last name:
Birthdate:
Sex: Male
Female
Ethnicity:
African-American/Black
American Indian/Alaska Native
Asian-American
Chinese/Chinese-American
East Indian/Pakistani
Filipino/Filipino-American
Japanese/Japanese American
Korean/Korean American
Latin American
Mexican/Mexican-American/Chicano
Native-American/Alaskan
Other
Other Asian
Other Spanish-American/Latino
Pacific Islander
Vietnamese/Vietnamese-American
White/Caucasian
 
City and country of permanent residence:
Citizenship:
Current address:
 
City:
State:
Zip:
Phone number:
Email address:
   
Parent's/permanent address:
 
City:
State:
Zip:
Permanent phone:
   
Family Background
Parents’ highest level of formal education:
(check one box for each parent)
 

Father

Mother

No high school

Some high school

Some college/university

2-year college graduate

4-year college graduate

Post graduate study

Occupation of father:
Occupation of mother:
Number of brothers:
Ages:
Number of sisters:
Ages:
Number of brothers and sisters
attending college:
Number of brothers and sisters
graduated from college:
   
Education
Home Institution (school):
Class level Summer of program:
Expected graduation date:
Major:
Math
classes completed:

Name of Class

Semester/Year
Programming
classes completed:

Name of Class

Semester/Year
Science / engineering
classes completed:

Name of Class

Semester/Year
List the classes you are enrolled in
for this Spring semester:
List any school activities, clubs or programs you have participated in, including offices held and academic honors earned. Also list non-school clubs, activities, program or conferences in which you have participated.
   
Financial Aid
Have you filed the FAFSA form? Yes       No
If you have filed the FAFSA, please indicate your estimated family contribution (EFC):
Did you or your family receive any income during the past 5 years from public assistance programs, such as welfare, AFDC, Social Security, disability, etc.? Yes       No
If yes, list program(s):
Are you applying for any other internships this summer? Yes       No
If yes, list program(s):
   
Personal Statement

In your personal statement, please answer each of the following questions. Your answer should be approximately 75-100 words for each question:
Please check the research areas in which you would be interested in working.

Assistive Technology
Autonomous Systems/Robotics
Bioinformatics
Computer Architecture
Embedded Systems
FPGA CAD and graph algorithms
Sensor Networks
Software Engineering
Storage systems
Wireless networks
What interests you about the research areas you have chosen above?
How do you hope this summer research program will help you to attain your career goals?
What is your intended major and why have you chosen this field?
Please describe any academic or work experiences that are relevant to this internship program or that have sparked your interest in research.
If your academic performance and participation do not accurately reflect your potential, please describe any circumstances or conditions that may have prevented you from giving your best performance.
SURF-IT is particularly interested in increasing the diversity of students who transition to graduate school in computing and engineering. How might you aid this goal, in SURF-IT and beyond?
  
Letters of Reference

Give the names and email addresses of two individuals who will be writing letters of reference for you (it is strongly encouraged that at least one letter is from a science or math faculty member at your current college). A printable letter of recommendation is also available, which your recommender can return by mail.
1. Name:
Email:
   
2. Name:
Email:
  
Transcripts
Send copies of your official or unoffical transcripts to:

SURF-IT
School of Engineering
UC Santa Cruz
1156 High Street
Santa Cruz, CA 95064

or

surf-it@soe.ucsc.edu
 
CERTIFICATION

I certify that the information reported on this application, to the best of my knowledge, is true and correct. I authorize SURF-IT to release the information in this application to the selection committee, and to review my academic transcripts. I also authorize SURF-IT to release information on this application to the National Science Foundation.

If I am selected as a participant, I authorize SURF-IT and UC Santa Cruz to publicize any relevant scholarship and biographical information and/or publish photographs. I also agree to participate in the assessment of SURF-IT by completing surveys and participating in focus groups and/or interviews regarding my perceptions and personal experiences in the program. I understand that all information will be treated as confidential by the researcher.
  I understand and accept these terms.


For questions or more information, email surf-it@soe.ucsc.edu.