Summer Engineering Research Internship for US Students (SERIUS)
Application Form
A. Personal Details
Name (Please underline Family/Last Name)
Gender (for allocation of housing)
Male
Female
Nationality
Email Address (primary method of contacting you)
Telephone Number (include country code)
Cellphone Number (include country code)
Permanent Address
Address while at Home University
Special Requirements (e.g. medical conditions)
B. Emergency Contact Person
Name
Relationship
Email Address
Address
Telephone Number
(include country code)
Cell Number (include country
code)
C. Your Academic Information
Home University
Degree Program Enrolled In (e.g. BEng, BAppSci, etc)
Major
Current year of study (as at Jan 2014) (e.g. 2nd-year)
Computer Software / Programming Knowledge (e.g. FORTRAN, C++)
D. SELECTION OF RESEARCH PROJECT
(Please list your choices in order of preference)
Project Title
1
2
3
Name of Supervisor(s)
D. STATEMENT OF PURPOSE
Please provide a short write-up of not more than 500 words stating the motivation for applying for the
projects you have selected.
E. OTHER INFORMATION
Please list any other experience and/or non-curriculum-related activities that may be relevant to your
application (e.g. work experience, volunteer activities, community involvement, sporting/cultural
achievements).
Please submit your application, together with the relevant documents, to your university’s study
abroad offices:
1. Johns Hopkins University: Office of Study Abroad, jhuabroad@jhu.edu
2. University of Illinois at Urbana-Champaign: International Programs in Engineering Office (IPENG),
ipeng@illinois.edu
3. Olin College of Engineering: Ms Carol Kelley, Student Services Manager, carol.kelley@olin.edu
4. Arizona State University: Ms Jennifer Moy, ASU Study Abroad Office, jennifer.moy@asu.edu
5. University of Pittsburgh: Dr Diane Hardy Saran, Associate Director, International Engineering
Initiatives, dmhardy@pitt.edu
6. University of Wisconsin-Madison: Please complete the IAP online application at
https://www.studyabroad.wisc.edu/uwstudent_login.asp. Please contact Mr Andy
Quackenbush, International Academic Programs,quackenbush@studyabroad.wisc.edu if you
have any questions.
Documents to be submitted include
1) Application Form
2) Detailed Resume
3) Transcripts of academic records, including full details of all university-level courses (scanned
copies)
Project supervisors may interview candidates via email or Skype. You will be informed of the
outcome of your application by February 29, 2016.