Application Form
Particle Astrophysics for Undergraduates
International Research Experiences to Excite, Engage, and Train Next Generation STEM
Professionals
Application Due: February 1, 2015
Application Instructions:
Please attach undergraduate academic transcripts to the back of the application form.
Unofficial transcripts are acceptable.
Please sign and date the application.
Send the completed application with attached academic transcript(s) to:
Suruj Seunarine
email:surujhdeo.seunarine@uwrf.edu
Physics Dept.
UW-River Falls
River Falls, WI 54022
Letter of reference from should be submitted by the letter writer to the above address.
Applicant Name __________________________________________
Institution __________________________________________
Academic Department __________________________________________
Year in School � Sophomore � Junior � Senior
Citizenship Status (check one) � U.S. Citizen � Permanent Resident � Other
If Permanent Resident/Other Country of Citizenship __________________
Institutional Contact Information:
Academic Department __________________________________________
Institution __________________________________________
Institution Address __________________________________________
__________________________________________
Telephone ____________________________
E-mail ____________________________
Home Contact Information (during the academic year):
Home Address __________________________________________
__________________________________________
Telephone ____________________________
Permanent Home Contact Information: � Same as above
Home Address __________________________________________
__________________________________________
Telephone ____________________________
Academic Information:
Academic Major __________________________________________
Degree Objective � B.A. � B.S. � Other __________
Expected Graduation Date ____________________________ (as MM/YYYY)
If at a two year college, please state which school you expect to transfer to:
______________________
Name of: � Department Chair __________________________________________
or
� Major Advisor __________________________________________
Transcripts
Please attach one copy of undergraduate academic transcripts to the back of this
application. Transfer students should include transcripts from all undergraduate
institutions attended.
Grade Point Average (GPA) Overall GPA ________ Major GPA ________
Letters of Reference:
Applicants should request a letter of reference from someone able to comment on
the applicant’s academic background and readiness to participate in a rigorous research
experience at an international site. The writer should be provided a copy of the
reference request form with completed FERPA waiver section. The recommender may also
find it useful to have a copy of the completed application. The reference letter should be
submitted by the writer directly to UW-River Falls at the address on the first page.
Reference letters requested from:
Name Affiliation (Department and Institution)
_____________________________ ____________________________________
____________________________________
The letter should: Give a concise description of your research interests in this program. State how
participation in the program will benefit your academic training and how it will further
your intended professional career. (Limit your answer to this space.)
Describe any previous research work you have performed, and note its relevance (if any)
to this program. State explicitly whether the work you describe was part of an
undergraduate independent study or honors project, an REU experience, or a research
experience acquired through employment. Do not list organized laboratory coursework at
your university, but do be certain that laboratory courses are clearly identified on your
transcript(s).
Applicant Certification and Signature:
I certify that the information provided in this application is correct and true to the best of
my knowledge.
Applicant’s Signature _______________________________________
Date _________________________
Particle Astrophysics for Undergraduates:
International Research Experiences to Excite, Engage, and Train Next Generation STEM
Professionals
Reference Request Form
Due: February 1, 2015
Applicant must fill out the top portion of this form and give it to the recommender.
Applicant Name _______________________________________________________
The Family Educational Rights and Privacy Act provides rights and protections regarding
the disclosure of records held by educational institutions. These rights and protections
apply to materials in any medium, which contain information related directly to a student
and from which a student can be individually identified. By signing the waiver statement
below, I waive my right to inspect this reference letter. This waiver applies to all future
holders of the solicited letter.
� I waive my right of access to this reference letter.
_________________________________________________
(Applicant signature and date)
OR
� I do not waive my right of access to this reference letter. (If waiver statement is
unsigned, the student is specifically reserved the right of access to this reference letter.)
_________________________________________________
(Applicant signature and date)
Recommender Instructions:
1. Please read and complete this reference request form, supplying the information
requested below. If you wish to use your own institutional stationery, please
attach this completed form to your letter.
2. Please sign and date the reference report where indicated.
3. Please transmit completed form, together with your reference report:
Suruj Seunarine
Physics Dept.
UW-River Falls
River Falls, WI 54022
Reference Report
Recommender’s Name _________________________________________
Department __________________________________________________
Institution ___________________________________________________
Address _____________________________________________________
____________________________________________________________
Telephone _______________________
Fax ____________________________
E-mail __________________________
In you reference report please address the following:
 How long, and in what capacity, have you known the applicant?
 How will participation in this program benefit the applicant in pursuit of his/her academic
and professional careers?
 Describe the applicant’s potential for academic and professional achievement.
 Please comment on the applicant’s readiness to conduct scholarly research in an
 international setting.
I rank this applicant in the top ______ % of undergraduate students I have known.
Recommender’s Signature ________________________ Date ____________________