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.


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Sex:      (  ) Male        (  ) Female


Citizenship:     (  )  United States
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Disabled:      (  )  Yes
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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 meets the latest ADA standards.






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If yes, did you serve in Vietnam?     (  )  Yes
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Ethnicity     (  )  American Indian or Alaskan native
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Please email this form to:

              uwreu@phys.washington.edu

or mail to:

              Research Experiences for Undergraduates
              c/o Shizue Shikuma
              Institute for Nuclear Theory
              University of Washington
              Box 351550
              Seattle, WA 98195-1550