California State University, Dominguez Hills s2

CALIFORNIA STATE UNIVERSITY, DOMINGUEZ HILLS

OFFICE OF UNDERGRADUATE RESEARCH, SCHOLARSHIP AND CREATIVE ACTIVITY

STUDENT RESEARCH FELLOW APPLICATION

DEADLINE: 4:59 PM, May 1, 2015

Submit this cover sheet with signatures as a scanned .pdf or .jpg file to the Office of Undergraduate Research, Scholarship, and Creative Activity at by 4:59 PM, May 1, 2015.

Name: ______

Last First Middle

Address: ______

Street City State Zip Code

Telephone: ______Email: ______

Citizenship: _____ US Citizen _____ Permanent Resident

CSUDH Student ID number: ______

Are you eligible for Federal Work Study funds? Yes ______No ______

(If you’re unsure, you can find out through the CSUDH Financial Aid Office.)

Applicant Signature ______Date______

Faculty Sponsor Signature ______Date______