Application for COSAM Undergraduate
Competitive Research Fellowship 

Click HERE to fill out the online application instead

Please print or type

 

Name  _________________________________________________________                        __                  First                                      Middle Initial                                             Last

Permanent
Mailing Address                                                                                                       ___                                 Number                                       Street                                Apt No  

                                                                                                                                 
          City                                              State                                          Zip Code

Local
Mailing Address                                                                      __                                                                        Number                                    Street                                Apt No  

                                                                                                                                                City                                              State                                             Zip Code

Home(___) ________ Local(___)________     _____ _____ ____         _____/______/______
 Telephone Numbers                          Social Security Number               Birth Date

__Freshman    __Sophomore    __Junior    __Senior                              ______________________
Present Status – Please check correct level                                        Anticipated Graduation Date

What is your major?                                                                                                              

Current Cumulative G.P.A. ______________        Current G.P.A. in Major_______________

How many semesters________ have you been at Auburn University?

Are you in Honors College? ____ yes  _____no

Please indicate your faculty mentor                                                                                                                                                                                       Must be a COSAM faculty member

Please state briefly (half page maximum) what is your long-term career goal and how this fellowship would contribute to that goal.

In the space below (half page maximum), list those honors, awards, and pertinent activities, (high school, college, civic, etc.) that best reflect your achievements.

Please list the names, affiliations, campus and email addresses, and phone numbers of two persons, one of whom is your mentor, from whom you have requested letters of recommendation.

1. Mentor:

2.

Use ONLY the space below to state: (1) your interest in research and (2) the general research plan that will be undertaken should you be awarded this fellowship. This research plan should be discussed with your mentor.

I hereby certify that the information found on this application is correct and I authorize the release of this information to the Fellow Selection Committee. My mentor and I have read the Reporting Requirements, Extra Activities, and Responsibilities of the Mentor, and agree to fulfill these commitments.

__________                   _________                                                   __________________

       Applicant Signature                                                                                         Date

_____________________________                                                      __________________

        Mentor Signature                                                                                           Date

Please submit this application and recommendation letters to:

Dr. Chris Rodger
Associate Dean for Research and Graduate Studies, COSAM
248 SCC
Auburn University, AL 36849