2020 REU Site: Nanotechnology for Health, Energy & the Environment at Stony Brook

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Thank you for your interest in the 2020 REU: Nanotechnology for Health, Energy and the Environment program at Stony Brook University! For inquiries, you may email CIE_GraduateSchool@stonybrook.edu or call 631-632-1386.

Program Dates: May 26th (move in) – July 31, 2020; Priority Application Deadline: March 1, 2020

PART 1 - DEMOGRAPHIC INFORMATION

First Name *

Middle Name

Last Name *

Preferred Email Address *

I identify my gender as *

Female

Male

Non-binary

Prefer not to say

Other:

Date of Birth (MM/DD/YY) *

Citizenship *

US Citizen

US Permanent Resident`

Other

Ethnic Self-Identification *

Please check all that apply

American Indian or Alaska Native (i.e. Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc.)

Asian (i.e. Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc.)

Black or African American (i.e. African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc.)

Native Hawaiian or Other Pacific Islander (i.e. Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.)

Hispanic, Latino, or Spanish Origin (i.e. Mexican or Mexican American, Puerto Rican, Cuban, Salvadorian, Dominican, Colombian, etc.)

White or Caucasian (i.e. German, Irish, English, Italian, Polish, French, etc.)

Other

Other:

Required

Have you served in the military? *

Yes

If yes, what branch? Dates of service?

Permanent mailing address *

Street Address, City, State, Zip Code

Current mailing address

If different from above

Preferred address for correspondence *

Permanent

Current

If current, valid until date

Cell phone # *

Alternate phone #

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