TIO/TAMUG UNDERGRADUATE STUDENT FELLOWSHIP

APPLICATION FORM

DUE NO LATER THAN WEDNESDAY, DECEMBER 3, 2008

Date of Application:                  ________________________________________________

 Name of Applicant:                   ________________________________________________

 Address:                                   ________________________________________________

 Telephone Number:                  ________________________________________________

 E-MAIL:                                  ________________________________________________

 Major:                                      ________________________________________________

 Number of Credits Needed to Graduate:           ____________________________________

 GPA (Overall and Major):        ______________ (Overall)      _________________(Major)

 Sponsor’s Name:                      ________________________________________________

 Sponsor’s Department: ________________________________________________

 Sponsor’s Telephone No:         ________________________________________________

 Sponsor’s FAX:                       ________________________________________________

 Sponsor’s E-MAIL:                 ________________________________________________

 Project Title:                             ________________________________________________

I agree to work a minimum of 200 hours on                         I agree to provide instruction, laboratory

this project.  I agree to participate in the                            space, supplies and equipment for this

TAMUS Pathways Symposium or the                                  project.

TAMUG Student Poster Session.

____________________________________                        ___________________________________

Applicant’s Signature                                                                Sponsor’s Signature