REU Optional Information Form

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:

Social security number:

Date of birth:

Sex: Male Female

Citizenship:
United States
Other (please specify)

Disabled: Yes No

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.

Are you a veteran? Yes No

If yes, did you serve in Vietnam? Yes no

Ethnicity:
American Indian or Alaskan native
Asian or Pacific Islander
Black
Hispanic
Caucasian (non Hispanic)

You may also mail this form to:

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