Form

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If you have technical difficulties with the form please contact Tina Markos, tmarkos1@uwyo.edu or 307-268-2412.
Name*
First Name Last Name
Student ID*
Birth Date*
Month Day Year
E-mail*
So that we can get back to you
Phone Number*
- Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Hometown*
Home state*
Are you a resident of Wyoming?*

Yes No
What is your year in school?*
Expected graduation date
Month Day Year
What is your Major?*
Second Major?
Minor?
Are you in the UW Honors Program*
UW GPA:*
Transfer GPA:
Are you a first generation college student? (Neither parent has a bachelor's degree.)*

Yes No
What is the HIGHEST degree you eventually hope to earn?*
Once you finish your current degree program, what do you see as the IMMEDIATE next step in your career path?*
If you indicated other, please explain.
What are your long-term Career Goals?*

To conduct research in an industry setting To conduct research at a university To practice medicine To teach (grades K-12) To teach (college/university level) To work in the allied health professions (nursing, pharmacy, etc.) Other
If you indicated other, please explain.
Title of Research Proposal:*
Faculty Mentor's Last Name:*
Faculty Mentor's First Name:
Faculty Mentor Department:*
Last Name of 1st Faculty Reference:*
First Name of 1st Faculty Reference:
Department of 1st Faculty Reference:*
Last Name of 2nd Faculty Reference:*
First Name of 2nd Faculty Reference:
Department of 2nd Faculty Reference:*
Have you received an INBRE or EPSCoR fellowship before?

Yes No
If so what semesters?
Please submit the following documents with your application:

resume, unofficial transcripts, project summary, research proposal, mentor letter of support*, and 2 faculty reference letters*
For best results we recommend submitting all your documents as one pdf file, but you may upload multiple documents.

* Faculty may email letters directly to Lisa Abeyta labeyta1@uwyo.edu
Upload File
Upload a File
You can upload any type of file. Max: 300 MB
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The University's policy has been, and will continue to be, one of nondiscrimination, offering equal opportunity to all employees and applicants for employment on the basis of their demonstrated ability and competence without regard to such matters as race, sex, gender, color, religion, national origin, disability, age, veteran status, sexual orientation, genetic information, political belief, or other status protected by state and federal statutes or University Regulations.
Should be Empty:

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Please submit the following documents with your application:

For best results we recommend submitting all your documents as one pdf file, but you may upload multiple documents.

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