# Research Participation Program

**Administered by the Oak Ridge Institute for Science and Education**

**APPLICATION**

+-----------------------------------------------------------------------+
| Instructions to applicant                                             |
+-----------------------------------------------------------------------+
| 1.  Submit **completed application** form and attach the following    |
|                                                                       |
|     a.  Resume (include list of any papers, presentations, or         |
|         publications)                                                 |
|                                                                       |
|     b.  Two copies of reprints or abstracts, if available             |
|                                                                       |
| 2.  Submit **three references** from persons familiar with your       |
|     educational and professional qualifications (include your thesis  |
|     or dissertation adviser, if applicable)                           |
|                                                                       |
| 3.  Have **university transcripts** (all schools attended) sent to    |
|     the address below (copies accepted)                               |
|                                                                       |
| 4.  The complete application and supporting materials will be         |
|     reproduced for review by program officials.                       |
|                                                                       |
| 5.  Incomplete applications may not be considered                     |
|                                                                       |
| 6.  Additional information may be required if an appointment is       |
|     offered                                                           |
|                                                                       |
| 7.  Applications are accepted throughout the year                     |
|                                                                       |
| 8.  Eligibility Requirements:                                         |
|                                                                       |
|     a.  **Postgraduate:**                                             |
|                                                                       |
|         1.  Degree must be received within three years of the desired |
|             starting date or completion of all requirements for the   |
|             degree should be expected prior to the starting date.     |
|                                                                       |
|         2.  U.S. Citizenship                                          |
|                                                                       |
|     b.  **Student:**                                                  |
|                                                                       |
|         1.  Current student in good standing in an undergraduate or   |
|             graduate degree program                                   |
|                                                                       |
|         2.  Cumulative grade point average of 2.50 or higher, based   |
|             on A=4.0 scale                                            |
|                                                                       |
|         3.  U.S. Citizenship                                          |
|                                                                       |
|         4.  Minimum twelve credit hours per academic year             |
|                                                                       |
|     c.  F**aculty:**                                                  |
|                                                                       |
|         1.  Full-time permanent faculty member at an accredited U.S.  |
|             college or university                                     |
|                                                                       |
|         2.  U.S. citizenship                                          |
|                                                                       |
|         3.  Certification of Salary                                   |
+-----------------------------------------------------------------------+

+---------------------------------+------------------------------------+
| Return completed material to:   | For additional information about   |
|                                 | opportunities please contact:      |
| Betty Bowling                   |                                    |
|                                 | <http://www.orau.gov/orise.htm>    |
| **Research Participation        |                                    |
| Programs**                      | or                                 |
|                                 |                                    |
| **Oak Ridge Institute for       | ***Ms. Betty Bowling,* (865)       |
| Science and Education**         | 576-8503**                         |
|                                 |                                    |
| **P.O. Box 117 MS-36**          | [bowlin                            |
|                                 | gb@orau.gov](../bowlingb@orau.gov) |
| ###                             |                                    |
| #####  Oak Ridge, TN 37831-0117 | Or                                 |
|                                 |                                    |
| **Fax# (865) 241-5219**         | ***Ms. Sharon Kern,* (865)         |
|                                 | 576-9361**                         |
|                                 |                                    |
|                                 | [ker                               |
|                                 | ns@orau.gov](../pattersn@orau.gov) |
+---------------------------------+------------------------------------+

**APPLICATION**![](media/image1.wmf){width="2.4569444444444444in"
height="0.5701388888888889in"}

**Research Participation Program**

Please type or print clearly and return the completed original
application form and [all]{.underline} supporting materials to the Oak
Ridge Institute for Science and Education (address on previous page).

  --------------------------------------------------------------------------
  **Please indicate specific facilities that interest you**

  **List Project Number(s) if Applicable**
  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  **Federal Bureau of Investigation - Counterterrorism/Forensic Science
  Research Unit (FBI-CTFSRU)**
  --------------------------------------------------------------------------

**(circle one) POSTGRADUATE FACULTY STUDENT** SO ( ) JR ( ) SR ( ) Tech
Sch ( )

Highest Degree Received \_\_\_\_\_\_\_\_\_\_\_\_\_ Date of Graduation
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date Received \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Degree
Discipline \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1\. Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(last, first middle)

Social Security Number \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\. Current Mailing Address Phone
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3.  Permanent Mailing Address Phone
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Email
Address\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4\. Have you ever been investigated for a Security Clearance? Yes No

5\. U.S. citizen? Yes No Guidelines stipulate that only U.S. citizens
will be eligible for these programs.

6\. Academic history (begin with current or most recent; list all
colleges and universities attended).

+------------------------+--------+-------+--------+----------+------+
| Institution/campus     | Dates  | D     | Date   | Major    | G    |
|                        |        | egree | a      |          | rade |
|                        | From   |       | warded |          | P    |
|                        | To     |       |        |          | oint |
|                        |        |       | or     |          | A    |
|                        |        |       | ex     |          | vera |
|                        |        |       | pected |          | ge\* |
+------------------------+--------+-------+--------+----------+------+
|                        |        |       |        |          |      |
+------------------------+--------+-------+--------+----------+------+
|                        |        |       |        |          |      |
+------------------------+--------+-------+--------+----------+------+
|                        |        |       |        |          |      |
+------------------------+--------+-------+--------+----------+------+
|                        |        |       |        |          |      |
+------------------------+--------+-------+--------+----------+------+

\*\[GPA basis: A=4, B=3, C=2, D=1. Attach explanation if your transcript
uses different basis.\]

7\. List three persons familiar with your educational and professional
qualifications who have been asked to submit reference forms directly to
ORISE (include your thesis or dissertation adviser, if applicable)

  ------------------------ ---------------------- ------------------------
  Name                     Position               Address

                                                  

                                                  

                                                  
  ------------------------ ---------------------- ------------------------

8\. List any members of facility scientific staff with whom you have had
contact.

  -------------------------------------- --------------------------------
  Name                                   Installation/Division

                                         

                                         
  -------------------------------------- --------------------------------

9\. Academic honors

  --------------------------- --------------------------- ----------------
  Award                       Institution/Campus          Inclusive dates

                                                          

                                                          

                                                          
  --------------------------- --------------------------- ----------------

10\. Relevant employment record; begin with current (include part-time,
full-time, military, and summer)

  ------------ ------------ ---------------------------- ----------------
  From         To           Employer                     Type of work

                                                         

                                                         

                                                         
  ------------ ------------ ---------------------------- ----------------

11\. List computer languages with which you are familiar and your level
of proficiency (very good/good/fair).

a\. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ b.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ c.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

d.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ e.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ f.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

12. Describe relevant educational or research experiences. Include
    patents you have received or for which you have applied.

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

13\. Describe the educational and professional goals you expect to
achieve as a result of participating in this program; include your
future career plans.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

14\. How did you find out about this program?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

The complete application and supporting materials will be reviewed by
ORISE and reproduced for submission to the host facility for review and
selection.

SIGNATURE\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

***Return to*: Attn: Betty Bowling, Oak Ridge Institute for Science and
Education, MS-36, P.O. Box 117, Oak Ridge, TN 37831-0117/Fax (865)
241-5219**

![](media/image1.wmf){width="2.4569444444444444in"
height="0.5701388888888889in"}

**REFERENCE FORM**

**Research Participation Program**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Please type or print clearly and return the original form to Oak Ridge
Institute for Science and Education address below). A letter may be
substituted, if more convenient.**

**APPLICANT**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(last, first, middle)

How long and in what association have you known the
Applicant?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

In a group of 100 other scientists and engineers of comparable
experience, how would you rate the applicant with respect to the
following [personal characteristics]{.underline}:

+-------------------------------+----+----+----+----+-----+--------+
|                               | B  | A  | A  | Ou | Su  | Inad   |
|                               | el | ve | bo | t- | per | equate |
|                               | ow | ra | ve |    | ior |        |
|                               |    | ge |    | St |     | Oppor  |
|                               | A  |    | A  | an |     | tunity |
|                               | ve |    | ve | di |     |        |
|                               | ra |    | ra | ng |     | To     |
|                               | ge |    | ge |    |     | O      |
|                               |    |    |    |    |     | bserve |
+-------------------------------+----+----+----+----+-----+--------+
|                               | Lo | Mi | Ne | H  |     |        |
|                               | we | dd | xt | ig |     |        |
|                               | st | le | 20 | he |     |        |
|                               | 40 | 25 |    | st |     |        |
|                               |    |    |    | 15 |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Motivation toward a          |    |    |    |    |     |        |
| successful productive career* |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Growth during total period   |    |    |    |    |     |        |
| observed*                     |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Fertility of imagination;    |    |    |    |    |     |        |
| originality of thought*       |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Emotional stability and      |    |    |    |    |     |        |
| maturity*                     |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Ability to work with others* |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Self-reliance and            |    |    |    |    |     |        |
| independence*                 |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+

In a group of 100 other scientists and engineers of comparable
experience, how would you rate the applicant with respect to the
following [scientific capabilities]{.underline}:

+-------------------------------+----+----+----+----+-----+--------+
|                               | B  | A  | A  | Ou | Su  | Inad   |
|                               | el | ve | bo | t- | per | equate |
|                               | ow | ra | ve |    | ior |        |
|                               |    | ge |    | St |     | Oppor  |
|                               | A  |    | A  | an |     | tunity |
|                               | ve |    | ve | di |     |        |
|                               | ra |    | ra | ng |     | To     |
|                               | ge |    | ge |    |     | O      |
|                               |    |    |    |    |     | bserve |
+-------------------------------+----+----+----+----+-----+--------+
|                               | Lo | Mi | Ne | H  |     |        |
|                               | we | dd | xt | ig |     |        |
|                               | st | le | 20 | he |     |        |
|                               | 40 | 25 |    | st |     |        |
|                               |    |    |    | 15 |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Mastery of fundamental       |    |    |    |    |     |        |
| knowledge in field*           |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Skill and originality in     |    |    |    |    |     |        |
| design of research projects*  |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Laboratory skill and         |    |    |    |    |     |        |
| technique*                    |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Ability to communicate       |    |    |    |    |     |        |
| information (written-oral)*   |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+

In the space below, add any descriptive comments, which will assist in
providing a complete picture of the applicant's character, attitude, and
ability/potential for an appointment. Please comment on weaknesses as
well as strong points. Use additional sheets if necessary.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Signature**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**Date**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Typed or printed
name**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**Title\_\_\_\_\_\_\_\_\_**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Mailing Address**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_­­­­­­­­­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**Email
Address**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

***[Return To]{.underline}:* Attn: Betty Bowling, Oak Ridge Institute
for Science and Education, MS-36, P.O. Box 117, Oak Ridge, TN
37831-0117/Fax (865)241-5219**

![](media/image1.wmf){width="2.4569444444444444in"
height="0.5701388888888889in"}

**REFERENCE FORM**

**Research Participation Program**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Please type or print clearly and return the original form to Oak Ridge
Institute for Science and Education address below). A letter may be
substituted, if more convenient.**

**APPLICANT**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(last, first, middle)

How long and in what association have you known the
Applicant?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

In a group of 100 other scientists and engineers of comparable
experience, how would you rate the applicant with respect to the
following [personal characteristics]{.underline}:

+-------------------------------+----+----+----+----+-----+--------+
|                               | B  | A  | A  | Ou | Su  | Inad   |
|                               | el | ve | bo | t- | per | equate |
|                               | ow | ra | ve |    | ior |        |
|                               |    | ge |    | St |     | Oppor  |
|                               | A  |    | A  | an |     | tunity |
|                               | ve |    | ve | di |     |        |
|                               | ra |    | ra | ng |     | To     |
|                               | ge |    | ge |    |     | O      |
|                               |    |    |    |    |     | bserve |
+-------------------------------+----+----+----+----+-----+--------+
|                               | Lo | Mi | Ne | H  |     |        |
|                               | we | dd | xt | ig |     |        |
|                               | st | le | 20 | he |     |        |
|                               | 40 | 25 |    | st |     |        |
|                               |    |    |    | 15 |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Motivation toward a          |    |    |    |    |     |        |
| successful productive career* |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Growth during total period   |    |    |    |    |     |        |
| observed*                     |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Fertility of imagination;    |    |    |    |    |     |        |
| originality of thought*       |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Emotional stability and      |    |    |    |    |     |        |
| maturity*                     |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Ability to work with others* |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Self-reliance and            |    |    |    |    |     |        |
| independence*                 |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+

In a group of 100 other scientists and engineers of comparable
experience, how would you rate the applicant with respect to the
following [scientific capabilities]{.underline}:

+-------------------------------+----+----+----+----+-----+--------+
|                               | B  | A  | A  | Ou | Su  | Inad   |
|                               | el | ve | bo | t- | per | equate |
|                               | ow | ra | ve |    | ior |        |
|                               |    | ge |    | St |     | Oppor  |
|                               | A  |    | A  | an |     | tunity |
|                               | ve |    | ve | di |     |        |
|                               | ra |    | ra | ng |     | To     |
|                               | ge |    | ge |    |     | O      |
|                               |    |    |    |    |     | bserve |
+-------------------------------+----+----+----+----+-----+--------+
|                               | Lo | Mi | Ne | H  |     |        |
|                               | we | dd | xt | ig |     |        |
|                               | st | le | 20 | he |     |        |
|                               | 40 | 25 |    | st |     |        |
|                               |    |    |    | 15 |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Mastery of fundamental       |    |    |    |    |     |        |
| knowledge in field*           |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Skill and originality in     |    |    |    |    |     |        |
| design of research projects*  |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Laboratory skill and         |    |    |    |    |     |        |
| technique*                    |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Ability to communicate       |    |    |    |    |     |        |
| information (written-oral)*   |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+

In the space below, add any descriptive comments, which will assist in
providing a complete picture of the applicant's character, attitude, and
ability/potential for an appointment. Please comment on weaknesses as
well as strong points. Use additional sheets if necessary.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Signature**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**Date**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Typed or printed
name**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**Title\_\_\_\_\_\_\_\_\_**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Mailing Address**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

######### Email Address \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

***[Return To]{.underline}: Attn: Betty Bowling,* Oak Ridge Institute
for Science and Education, MS-36, P.O. Box 117, Oak Ridge, TN
37831-0117/Fax (865)241-5219**

![](media/image1.wmf){width="2.4569444444444444in"
height="0.5701388888888889in"}

**REFERENCE FORM**

**Research Participation Program**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Please type or print clearly and return the original form to Oak Ridge
Institute for Science and Education address below). A letter may be
substituted, if more convenient.**

**APPLICANT**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(last, first, middle)

How long and in what association have you known the
Applicant?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

In a group of 100 other scientists and engineers of comparable
experience, how would you rate the applicant with respect to the
following [personal characteristics]{.underline}:

+-------------------------------+----+----+----+----+-----+--------+
|                               | B  | A  | A  | Ou | Su  | Inad   |
|                               | el | ve | bo | t- | per | equate |
|                               | ow | ra | ve |    | ior |        |
|                               |    | ge |    | St |     | Oppor  |
|                               | A  |    | A  | an |     | tunity |
|                               | ve |    | ve | di |     |        |
|                               | ra |    | ra | ng |     | To     |
|                               | ge |    | ge |    |     | O      |
|                               |    |    |    |    |     | bserve |
+-------------------------------+----+----+----+----+-----+--------+
|                               | Lo | Mi | Ne | H  |     |        |
|                               | we | dd | xt | ig |     |        |
|                               | st | le | 20 | he |     |        |
|                               | 40 | 25 |    | st |     |        |
|                               |    |    |    | 15 |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Motivation toward a          |    |    |    |    |     |        |
| successful productive career* |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Growth during total period   |    |    |    |    |     |        |
| observed*                     |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Fertility of imagination;    |    |    |    |    |     |        |
| originality of thought*       |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Emotional stability and      |    |    |    |    |     |        |
| maturity*                     |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Ability to work with others* |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Self-reliance and            |    |    |    |    |     |        |
| independence*                 |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+

In a group of 100 other scientists and engineers of comparable
experience, how would you rate the applicant with respect to the
following [scientific capabilities]{.underline}:

+-------------------------------+----+----+----+----+-----+--------+
|                               | B  | A  | A  | Ou | Su  | Inad   |
|                               | el | ve | bo | t- | per | equate |
|                               | ow | ra | ve |    | ior |        |
|                               |    | ge |    | St |     | Oppor  |
|                               | A  |    | A  | an |     | tunity |
|                               | ve |    | ve | di |     |        |
|                               | ra |    | ra | ng |     | To     |
|                               | ge |    | ge |    |     | O      |
|                               |    |    |    |    |     | bserve |
+-------------------------------+----+----+----+----+-----+--------+
|                               | Lo | Mi | Ne | H  |     |        |
|                               | we | dd | xt | ig |     |        |
|                               | st | le | 20 | he |     |        |
|                               | 40 | 25 |    | st |     |        |
|                               |    |    |    | 15 |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Mastery of fundamental       |    |    |    |    |     |        |
| knowledge in field*           |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Skill and originality in     |    |    |    |    |     |        |
| design of research projects*  |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Laboratory skill and         |    |    |    |    |     |        |
| technique*                    |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+
| *Ability to communicate       |    |    |    |    |     |        |
| information (written-oral)*   |    |    |    |    |     |        |
+-------------------------------+----+----+----+----+-----+--------+

In the space below, add any descriptive comments, which will assist in
providing a complete picture of the applicant's character, attitude, and
ability/potential for an appointment. Please comment on weaknesses as
well as strong points. Use additional sheets if necessary.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Signature**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**Date**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Typed or printed
name**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**Title\_\_\_\_\_\_\_\_\_**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Mailing Address**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

######### Email Address \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

***[Return To]{.underline}: Attn: Betty Bowling,* Oak Ridge Institute
for Science and Education, MS-36, P.O. Box 117, Oak Ridge, TN
37831-0117/Fax (865)241-5219**

![](media/image1.wmf){width="2.4569444444444444in"
height="0.5701388888888889in"}

**APPLICANT DATA**

**Research Participation Program**

**Applicant data is important in assessing the effectiveness of our
efforts to solicit applications from a diverse population. Your
completion and submission of this form will assist us in this regard.**

**Recognizing the importance of achieving a diverse group of
participants, selection will be based on several factors. These criteria
include, but are not limited to, disciplinary fields, academic records,
and recommendations, relevance to the host facility's mission, ethnic
background, and gender.**

**Providing this information is voluntary. If you decline to give this
information, it will in no way affect consideration of your
application.**

**Name\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

### Race \_\_\_\_\_ Caucasian, not of Hispanic origin (Having origins in any one of the original peoples of

###  Europe, North Africa, or the Middle East)

**\_\_\_\_\_ African-American (Having origins in any of the Black racial
groups of Africa)**

**\_\_\_\_\_ Hispanic (Of Mexican, Puerto Rican, Cuban, Central/South
American or other Spanish**

**culture of origin, regardless of race)**

**\_\_\_\_\_ American Indian (Having origins in any of the original
peoples of North America, and**

**maintaining cultural identification through tribal affiliation of
community recognition)**

**\_\_\_\_\_ Asian or Pacific Islander (Having origins in any of the
original peoples of the Far East,**

**Southeast Asia, the Indian Subcontinent, or the Pacific Islands\--for
example, India,**

**China, Japan, Korea, Philippine Islands, and Samoa)**

**\[ \] Male \[ \] Female Birth
Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**Month Day Year**

###  Birth Place: City/State: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Physical/mental handicap (physical or mental impairment that
substantially limits one or more major life activities\--for example,
blindness, deafness, or mobility impairment):**

**Yes\_\_\_\_\_\_ No\_\_\_\_\_\_**

**Other Name(s) Used
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**