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cdt@uoregon.edu P.O. Box 1995, Newport, OR 97365<br />

Lough Hyne IRES Program<br />

1. Applicant's Details:<br />

Applicant Name: __________________________________________<br />

Gender: Female Male<br />

Institution: _______________________________________________<br />

Academic Department: __________________________________________<br />

Year in College/University: Sophomore Junior Senior MS Student PhD Student<br />

If you are a senior, please list graduate schools <strong>to</strong> which you have applied:_______________<br />

___________________________________________________________________________<br />

If graduate <strong>student</strong>, what year? 1st 2nd 3rd 4th 5th<br />

If you are a finishing MS <strong>student</strong>, please list graduate schools <strong>to</strong> which you have<br />

applied:_______________________________________________________________________<br />

Please confirm that you are a <strong>student</strong> a time of application and will be at time of participation: yes no<br />

Citizenship Status (check one): U.S. Citizen Permanent Resident<br />

2. Institutional Contact Information:<br />

Academic Department: __________________________________________<br />

Institution: ____________________________________________________<br />

Institutional Address:____________________________________________<br />

_____________________________________________________________<br />

Telephone: _______________________ Fax:____________________________<br />

E-mail: __________________________<br />

3. Home Contact Information (during the academic year):<br />

Home Address:_________________________________________________<br />

_____________________________________________________________<br />

Telephone:_______________________ Fax:____________________________<br />

E-mail:__________________________<br />

4. Permanent Home Contact Information: Same as above<br />

Home Address:_________________________________________________<br />

_____________________________________________________________<br />

Telephone:_______________________ Fax:____________________________<br />

E-mail:__________________________<br />

5. Academic Information:<br />

Academic Major: __________________________________________<br />

Degree Objective: B.A., B.S., M.S., Ph.D., Other_______<br />

Expected Graduation Date: ____________________________ (as MM/YYYY)<br />

Name of: Department Chair _______________________________________ or<br />

Major Advisor __________________________________________<br />

Grade Point Average (GPA): Overall GPA ________ Major GPA ________<br />

Please check all courses that have been taken or will be taken in spring or summer <strong>term</strong>:<br />

Invertebrate Biology Spring Summer<br />

Marine Botany (Phycology) Spring Summer<br />

Ecology Spring Summer<br />

Ecological Methods Spring Summer<br />

Statistics Spring Summer<br />

Scientific Writing Spring Summer<br />

Independent Research____________________________________________________<br />

U.S.-Ireland International Research Experiences for Students (IRES)

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