Physics Research Experiences for Undergraduates
University of Washington
Optional Information Form

The following information is requested so that we can meet Federal reporting requirements. Your responses will not affect the disposition of your application in any way. Submission of this information is voluntary.

Applicant name:

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If you are disabled, please describe your disability and any special accommodations that might be required. The University of Washington Physics and Astronomy Building is accessible.

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If yes, did you serve in Vietnam? Yes no

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You may also mail this form to:

Research Experiences for Undergraduates
Institute for Nuclear Theory
University of Washington
Box 351550
Seattle, WA 98195-1550

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