Summer Undergraduate Research and Creative Achievements Forum Application

• First Name:
  
• Last Name:
  
• Major:
  
• Year in School:
  Pick One Freshman Sophomore Junior Senior
• Anticipated Graduation Date: (Please choose the month that best matches.)
  Pick One May 2010   December 2010   May 2011 December 2011 May 2012 December 2012 May 2013 December 2013 May 2014 December 2014
• College or University:
  
• E-mail Address:
  
• Local Phone or Cell:
  
• Hometown:
  
• State:
  Pick One Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other
• Zip Code:
  
• Country:
  
• Missouri House District: (Missouri Residents Only)
  (three-digit number, for example, 005 or 137)
• Missouri Senate District: (Missouri Residents Only)
  (two-digit number, for example 02 or 15)
• Note: If you do not know your district numbers, you can use your hometown zip code to look up your senate district here, and house district here.

• Mentor Name:
  
• Department:
  
• Campus Address:
  
• E-mail:
  
• Phone:
  

• Funding Source:
  Pick One A&S Undergraduate Research Mentorship Ann Crowe Essig Mentorship Program in Nursing CAFNR On Campus Research Internship College of Engineering Undergraduate Research Option Emerge Summer Internship and Graduate School Prep eResearch Fellowship EXPRESS F.B. Miller Undergraduate Research Program in Animal Sciences Food for the 21st Century Nutritional Sciences Program Gyeongsong National University Honors College Discovery Fellowship Life Sciences Undergraduate Research Opportunity Program McNair Scholars Program Missouri Academy MU Summer Research Internship in Cell & Molecular Biology MU Undergraduate Research Scholars Program NASA Space Grant Consortium Undergraduate Research Scholarships NSF Program Alliance for Collaborative Research in Alternative Fuel Technology NSF Undergraduate Mentoring in Environmental Biology NSF-REU Program in Biological Sciences & Biochemistry NSF-REU Program in Home Networking Technologies NSF-REU/NIH Program in Radiochemistry Plant Genomics Internship @ MU Stevens Chemistry Program USDA Agricultural Research Service U.S. Dept. of Energy MNSEC Summer Undergraduate Research Program U.S. Dept. of Energy INIE Summer MURR Undergraduate Research Scholarship U.S. Dept. of Energy University Partnership (UP) Program Other
• If "Other", please name:
  
• This project was completed as part of a capstone.

• Title:
  (15 words max. Only Capitalize the first word, scientifically appropriate words and proper nouns.)
  
• Authors:
  (Please include your mentor, but do not include titles, such as "Dr." Example: "Sarah Student and Michael E. Mentor.")
  
• Abstract Text:
  (300 word max.) Note: If you need special characters such as superscripts or Greek letters, input the Unicode designation for it. Unicode conversion table (opens in new window).
  

For valuable consideration, I do hereby authorize The Curators of the University of Missouri, a public corporation, and those acting pursuant to its authority to:

1. Record my participation and appearance on video tape, audio tape, film, photograph or any other medium.
2. Use my name, likeness, voice and biographical material in connection with these recordings.
3. Exhibit or distribute such recording using a private digital video network, or other mechanisms, in whole or in part without restrictions or limitation for any educational purpose which The Curators of the University of Missouri, a public corporation, and those acting pursuant to its authority, deem appropriate.
4. To copyright the same in its name or any other name it may choose.

I hereby release and discharge The Curators of the University of Missouri, a public corporation, its successors and assigns, its officers, employees and agents, and members of the Board of Curators, from any and all claims and demands arising out of or in connection with the use of such photographs, film or tape, including but not limited to any claims for defamation or invasion of privacy.

I hereby consent to the release of said video tape, audio tape, film, photograph or any other medium for the above-stated purposes and in accordance with the terms stated above, pursuant to the consent provisions of the Family Educational Rights and Privacy Act, 20 U.S.C. 1232 et.seq.

• Yes, I consent.
• No, I do not consent.