# Faculty and Student Team Program (FaST) Application

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### Personal Profile Information

1\. The appointment term for which you are applying is:

> Summer 2002

2\.

First Name Middle Name Last Name Suffix

3\. Please enter your three most commonly used e-mail addresses:

Primary:

> Alternate:
>
> Alternate:

4\. Current Address

Street:

City:

State/Province:

Zip Code:

Country:

Phone: (555)555-5555

5\. Permanent Address

Street:

City:

State/Province:

Zip Code:

Country:

Phone: (555)555-5555

Parent's Phone: (555)555-5555

6\. Citizenship:

> U.S. Citizen: Yes No
>
> ***If born in the U.S.:***
>
> U.S. City of birth:
>
> U.S. State of birth:
>
> ***If born outside the U.S.:***
>
> City of birth:
>
> Country of birth:

**OR**

Permanent Resident Alien (PRA) Status:\
(See <http://www.scied.science.doe.gov/scied/ERULF/faq.html#3> for
information regarding PRA eligibility.)

> Permanent Resident Alien: Yes No
>
> ***If you are a PRA, you must provide the following information:***
>
> PRA Number:
>
> Country of Citizenship:
>
> Country of Birth:
>
> City of Birth:
>
> Passport Number:
>
> Passport Expiration Date: mm/dd/yyyy

7\. All applicants must enter the following:

> Date of Birth: (mm/dd/yyyy)

8\. Select the option that best describes your academic status.

> If you are a graduating senior, please refer to the Graduating Seniors
> information page\
> (<http://www.scied.science.doe.gov/scied/ERULF/eligibility.html#grad_seniors>).
>
> Freshman
>
> Sophomore
>
> Junior
>
> Senior
>
> Graduating Senior

9\. Month and year of high school graduation: (mm/yyyy)

### Applicant Demographic Data

Responses to questions 9 -- 15 contain demographic information that is
used to evaluate the diversity of applicants. Your responses to these
questions do not affect your application and are not available to the
persons reviewing your application. If you choose not to provide this
information, it will in no way affect consideration of your application.

10\. Gender: Male Female

11\. Race/Ethnicity

> African American
>
> Asian/Pacific Islander
>
> Caucasian American
>
> Hispanic American
>
> Native American
>
> Other
>
> If you\'ve chosen other, please specify:
>
> (Note: Native American = American Indian, Eskimo, and other original
> peoples of North America)

12\. Approximate Family Income

> \$0 to \$20,000
>
> \$20,000 to \$40,000
>
> \$40,000 to \$60,000
>
> \$60,000 to \$80,000
>
> over \$80,000

13\. Sources of Support for Your Undergraduate Education (check all that
apply):

> Own or family earnings/savings Government or student loan
>
> Private loan College work-study
>
> Scholarship(s) or other Grants-In-Aid

14\. Marital Status

> Married Single

15\. Number of Dependents:

16\. Do you have special needs (e.g., visually impaired)?

17\. Are you a relative of an employee at the DOE Laboratory to which
you are applying?

> Yes No

18\. What is your primary language spoken?

19\. What other languages do you speak?

### Applicant School Information

20\. If you are selected as a participant in this DOE program, will you
receive academic credit from your university/college for participating?

Yes No Do Not Know

21\. College/University Currently Attending:

> College/University Address:

City:

State/Province:

Zip Code:

Country:

College/University Phone:

Name of College/University President:

Date Started: (mm/dd/yyyy)

> Major Expected/Declared:
>
> Biological Sciences -- Agriculture Biological Sciences -- Biological
> Biochemistry
>
> Biological Sciences -- Biology Biological Sciences -- Biophysics
>
> Biological Sciences -- Cell Biology Biological Sciences -- Ecology
>
> Biological Sciences -- Forestry Biological Sciences -- Genetics
>
> Biological Sciences -- Microbiology Computer Sciences
>
> Engineering -- Bioengineering Engineering -- Chemical
>
> Engineering -- Civil Engineering -- Computer
>
> Engineering -- Electrical Engineering -- Environmental
>
> Engineering -- Industrial Engineering -- Materials
>
> Engineering -- Mechanical Engineering -- Nuclear
>
> Engineering -- Petroleum Mathematics/Statistics
>
> Physical Sciences -- Astronomy Physical Sciences -- Chemistry
>
> Physical Sciences -- Earth Sciences Physical Sciences -- Environmental
> Sciences
>
> Physical Sciences -- Geological Sciences Physical Sciences --
> Oceanography
>
> Physical Sciences -- Physics Public & Science Policy Studies
>
> Social Sciences (including economics and psychology)
>
> Other
>
> Other Major:
>
> Minor and/or Concentration Expected/Declared:
>
> Expected Graduation Date (mm/dd/yyyy)
>
> Expected degree:
>
> 2 Year Associate Bachelors

22\. Please provide the following information about your current
academic advisor.

> First Name:
>
> Last Name:
>
> Phone:
>
> E-mail:
>
> Address 1:
>
> Address 2:
>
> City:
>
> State/Province:
>
> Country:
>
> Zip Code:

23\. a. What is the earliest date you can begin your appointment?
(month/day)

b\. When do you need to complete your appointment? (month/day)

24\. If you are participating in a National Science Foundation (NSF)
funded program, please identify the program from the following list:

> LSAMP (Louis Stokes Alliances for Minority Participation)
>
> ATE (Advanced Technological Education)
>
> REU (Research Experience for Undergraduates)
>
> CSEMS (Computer Science Engineering Mathematics)
>
> STEMPT (Science, Technology, Engineering & Mathematics Teacher
> Preparation)
>
> Other (Please indicate the name)
>
> Principal Investigator\'s or Manager\'s Name:
>
> Principal Investigator\'s or Manager\'s Phone Number: (555) 555-5555
>
> Principal Investigator\'s or Manager\'s E-mail Address:
>
> The grant number of your program (supplied by your Principal
> Investigator):

25\. a. Have you ever had an internship/fellowship with the Department
of Energy or any of its National Laboratories? Yes No

> b\. If yes, when and where did the internship/fellowship occur?
> Briefly describe your research project in 50 words or less:

26\. List all other colleges and universities that you have attended
(enter \"NONE\" if appropriate). Include approximate dates of attendance
and indicate any degrees earned:

27\. List all employment information including research experience, paid
or volunteer work (enter \"NONE\" if appropriate):

> ***28.. Choose at least one research area.***
>
> **First Choice** (select one)
>
> Astrophysics Biology
>
> Chemistry Computer Science
>
> Engineering Biomedical Engineering Chemical
>
> Engineering Civil Engineering Electrical
>
> Engineering Environmental Engineering Mechanical
>
> Environmental Science Geological Sciences
>
> Health Science Marine Science
>
> Material Science Mathematics
>
> Nuclear Science Other Science
>
> Physics Psychology
>
> Science Education Science Policy
>
> Science Writing Waste Management

29\. Certification of minimum GPA and minimum age eligibility
requirements:

\(1\) my cumulative GPA for all completed coursework is 2.5 or higher;

\(2\) I will be 18 years of age or older at the time of the appointment.

> I certify that the above information is correct (Click the box to
> certify both statements.)
>
> I understand that I may have to provide an official transcript in
> order to participate.

30\. Academic Honors or Awards. Enter \"NONE\" if applicable.:

31\. In chronological order, list **all** college courses (title and
number) you have completed and their respective **grades**. It may be
helpful to create this list using a word processor and then copy and
paste it below.

32\. List all courses you are currently taking. Enter \"NONE\" if
applicable.

33\. Indicate your proficiency in the following areas/instruments:

(1 = No Experience, 5 = Proficient)

> **Computer Skills 1 2 3 4 5**
>
> Computer Aided Design Software (CAD)
>
> Programming
>
> Spreadsheets
>
> Statistical analysis software
>
> Web design
>
> Word processing

34\. List any programming languages you are proficient in (e.g.. C,
Pascal, HTML, Java, etc.):

35\. List any additional computer related skills/experience you may
have:

36\. a. Rate your experience in using supplies, procedures and/or
equipment in the following list:

(1 = No Experience, 5 = Proficient).

Potential mentors use this list of lab skills to determine your
background and to assist in making the best match between applicants and
research projects. You are not expected to be proficient in all or many
of these lab skills.

> **Lab Skills 1 2 3 4 5**
>
> AD Converters
>
> Advanced Light Source
>
> Analytical Balance
>
> Atomic Absorption Spectroscopy
>
> Autoclave
>
> Calorimeter
>
> Centrifuge
>
> Electron Microscopy
>
> Electrophoresis
>
> Eppendorf Microliter Pipets
>
> Fume Hood
>
> Gamma Ray Detectors
>
> Gas Chromatography-Mass Spectroscopy (GCMS)
>
> Gas-Liquid Chromatography (GLC)
>
> High Performance Lasers
>
> High Performance Liquid Chromatography (HPLC)
>
> Incubators
>
> Infrared (IR) Spectroscopy
>
> Laminar Flow Hood
>
> Light Microscopy
>
> Nuclear Accelerator
>
> Nuclear Magnetic Resonance (NMR)
>
> Oscilloscope
>
> Parafilm
>
> Particle Accelerators
>
> pH Meters
>
> Polymerase Chain Reaction
>
> Power Supplies
>
> Serological Pipets
>
> Signal Generator
>
> Soldering Gun
>
> Spectrophotometer
>
> Spectroscopy
>
> Sterile Procedures
>
> Thermocouples
>
> UV/V\'s Spectrometer
>
> Vacuum Systems
>
> Volt/Ohm Meter
>
> Volumetric Measuring Devices
>
> X-Ray Detector
>
> X-Ray Diffractometer

b\. List any other lab skills, mechanical skills (such as operating a
fork lift), or carpentry skills that you have:

**Please answer each of the following questions in essay form using no
more than 250 words. We recommend you complete the essay questions using
a word processor (to check spelling and grammar) and then copy and paste
your answers into the text boxes.**

37\. Discuss any special skills you would like to exercise or develop
during your FaST appointment.

38\. What are your areas of interest and what type of research
activities would you like to be involved in at the lab?

39\. The unique experiences and cultural backgrounds of the
participating students influence the quality of FaST. What do you think
you would bring to the program?

40\. At this point in your education, what will your chosen profession
be and why?

41\. **Please answer one of the following questions using no more than
250 words.**

> What was the most rewarding educational experience you have had in
> science and /or technology? Why?
>
> **OR**
>
> Describe a frustrating project on which you worked and how you dealt
> with the challenges it presented.

### Graduating Senior Page

Only a limited number of internships are available for graduating
seniors. Your responses to the questions on this page are important
because they are used to select the graduating seniors who will most
benefit from this opportunity.

42\. a. Have you applied to graduate school?

> Yes No

b\. If so, which graduate school and in what academic area?

43\. What are your future plans and how will this internship enhance
them?

**Reminder:** Graduating Seniors interested in serving as program
assistants should choose a lab and choose "Science Policy" as their
research area.

### END OF APPLICATION