JPL SIRI Student Independent Research Intern Program

JPL SIRI – Student Independent Research Intern Program

Application Form

http://www.csupomona.edu/~zaliyazici/siri/siri.html

Name: Student ID#: ______

Address: ______

City: State: Zip: ______

Day Phone: Eve. Phone:______

Email: ______

Major: ______

Academic Standing (circle one): Graduate / Senior / Junior / Sophomore

Anticipated Graduation Date: ______

Qualifications:

1. USA Citizen (circle one): Yes / No

2. If not USA citizen, are you a Permanent Resident (circle one): Yes / No

(If Yes, country from ______)

3. Are you at least 18 years old? Yes / No

4. Cal Poly Pomona GPA: ______

References (list two faculty names in your major department and provide their contact information):

1. ______

2. ______

Please attach to this application:

 Resume (include the following information: long-term career goals, near-term academic plans, a list of skills (computer science, math, physical science, writing, etc.), work experience, and a sentence or two about any specific projects that reflect your best efforts to date, such as science projects, web sites, school papers, or publications)

 One copy of your transcripts (official or unofficial)

Applications must be submitted to Dr. Z. Aliyazicioglu, Building 9, Room 406 by 5 PM,

Monday, November 4, 2013.

Signature: ______Date: ______