Application for Physics Support Received:

Result: □ no □ yes

Semester year

A. Name Student ID:

Birth Date □ Male □ Female

Marital Status: □Single □ Married □ Divorced □ Widow

Residence

Address:

Number Street City State Zip Code

Telephone: ( ) - -

Employer: Telephone: ( ) - -

Address:

Number Street City State Zip Code

B. □ Physics Major □ Interested in Physics

□ Double Major: Physics and □ Other: Specify

□ Physics Minor: Major

How many credit hours have you completed?

Total undergraduate hours GPA

Physics courses attempted Physics courses completed

                  Lab previous semester register: □ fall □ spring □ summer year

How many credit hours are you registered in this semester?

Total: Physics Courses: Specify course number and course title.

C. Two letters of recommendation (sent directly to the department head) [optional]

C-1. Faculty member of the Department of Physics, Geology and astronomy:

Name Telephone

C-2. UTC faculty member:

Name Telephone

D. How many hours per week can you work in the department of PGA? Hr/wk.

Preference: □ Research □ Laboratory Preparation

□ Other: specify

E. Write on a separate sheet, showing y our opinion of Physics and why you need support.

For example: What will your project be, if you get the grant? Why do you wish to study physics? How does physics influence your career goals? Why do you need financial support?

F. Applicant's Signature

Date