APPLICATION for participation (Email to )
Priority Application Deadlines:

For positions starting in Fall 2017: May 1, 2017

For positions starting in Spring 2018: October 15, 2017

Student Information

Student Name / First Middle Last
E-mail Address
2nd E-mail Address
Permanent Mailing Address
Current School Address
Home Phone / School Phone
Mobile Phone
(if any)
College/University Name/City/State
Major / Minor (if any)
Cumulative GPA / GPA in last 60 hours
Expected Graduation Date / Semester: Spring Summer Fall
Year: 2014 2015 2016 2017 2018 2019 2020
Gender / Male Female
Ethnicity / Asian American African American Caucasian
Hispanic Multi-Racial Native American Other
US Immigration Status / Please attach proof of your US citizenship/permanent resident status to this application. It is a requirement of participation in this program.

Academic Information

Check the courses you have already completed or are currently taking and indicate next to the name the level (undergraduate/graduate/both)
Operating Systems / Machine Learning / Databases
Computer Networks / Natural Lang. Processing / Software Engineering
Computer Architecture / Algorithms & Data Struc. / Data Security
Data Mining / Computer & Network Sec. / Other security related course
If you checked the Other security related course give details here including level of course(s), where taken and grade(s) received:
An official transcript (i.e., sent directly from your school) of your college work to date should be received by the Program Director by May 15, 2017 for Fall (October 30 for Spring), at the address: SFS Program, c/o Program Director, Department of Computer Science, University of Houston, Houston, TX 77204-3010. In addition, list the courses you are taking in the latest academic year that are not listed on your transcript, using both course number and title.
List the honorary and professional societies of which you are a member, indicating offices held, as well as any extracurricular activities/organizations in which you participate.
Briefly describe your interest in participating in the UH SFS program
List any industrial or project experience.
Have you requested from your registrar that your official transcript is mailed to:
SFS Program, c/o Program Director, Department of Computer Science, University of Houston, Houston, TX 77204-3010:
Yes No
Provide any additional information you may want to communicate to the SFS committee

Reference Information

List two faculty members who will be submitting a letter of recommendation for your application in this program. The letters should be submitted online or sent directly to the SFS Program office listed on the recommendation form.

Faculty Name / First Middle Last
Title
Department
Institution
Office Phone
E-mail Address
Faculty Name / First Middle Last
Title
Department
Institution
Office Phone
E-mail Address

Please note that working for a federal, state, local, or tribal agency or organization after graduation for the same period of time as you receive the scholarship is a requirement of this program. Also summer internship(s) at such agencies is also a requirement for MS students and strongly recommended for PhD students. For these purposes, you will need to pass a background check and a stricter level of scrutiny such as Security Clearance as appropriate for the positions available.

Is there any reason why you would not pass either a background check or a security clearance check? Circle one

Yes No

If Yes, explain ______

Note that misdemeanor traffic violations are not an issue unless there is a pattern.

I have answered the questions above truthfully and completely.

Signature ______Date______

SFS Application 2017-18 Page 4 of 4