Minority Student Database and Online Directory Form

If you have previously submitted a registration form, you may update your information at any time by clicking here. You will need your record number and the password you chose when you submitted the form. If you are unable to remember you password, please contact the Web Editor.

When you complete the form below you will automatically be included in the MAS database and your e-mail address will be added to an electronic distribution list for minority program announcements and other information of interest to minority students (job announcements, academic opportunities, etc.) You may unsubscribe at any time by sending a message to benjamin.cuker@hamptonu.edu. Your name, e-mail and information about REU and minority program participation may be shared with REU and minority programs, but information will otherwise be confidential.

In addition, you can choose to be included in an online, publically searchable MAS Student Directory. The Directory provides a way of introducing minority students with interests in the aquatic sciences to each other and to the larger aquatic science community. Undergraduate students, graduate students, and high-school students are invited to participate.

Only U.S. citizens, permanent U.S. residents and temporary U.S. residents are eligible.

Please indicate whether you want to be included in the on-line Minority Student Directory.
If you check "yes", your full name, e-mail, current academic information, fields and areas of interest, and Statement of Interest will be included in a publically-searchable, online MAS Student Directory.

Yes No

Please choose a password and enter it in both spaces. You will need this password to update your record in future.

NAME AND CONTACT INFORMATION

Last/family name (ex. Ramirez-Flores):

First (given) name:

Middle (given) name:

Current Institutional Address

Department:

Institution:

Address line 1:

Address line 2:

City:

State/Province (US):

Zip/Postal Code:

Email Address:

Telephone (USA) (format xxx-xxx-xxxx):

Fax:

Permanent Mailing Address

Address line 1:

Address line 2:

City:

State/Province (US):

Zip Code:

BACKGROUND INFORMATION

Citizenship:

United States Citizen

Non-US Citizen, Permanent U.S. Resident Visa

Non-US Citizen, Temporary U.S. Resident Visa

Non-US Citizen

If not a US citizen, of what country are you a resident?

Other:


Ethnic/Cultural Background: (U.S. Citizens only. Please check no more than two codes that best describe your heritage.)
African American	Caucasian/White
Mexican American/Chicano	Asian
Puerto Rican	Multiethnic/Multicultural
Other Hispanic American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander

Gender:	Male Female

Month and Year of Birth:

The above information is requested, not required, but we hope you will provide it. Responses will be kept confidential, and only used for statistical purposes. These data are extremely important for human-resource needs and helps us characterize the student population and build programs that reflect the community and are most useful to participants. Thank you in advance for your help.

CURRENT EDUCATIONAL STATUS

Institution:

Degree Type:

Month and Year You Began Current Program:

If a Degree Program, Month and Year Degree is Expected:

Major or Expected Major ("undecided" is acceptable):

PREVIOUS EDUCATION: UNDERGRADUATE

Please list undergraduate colleges or universities attended PRIOR to your current academic institution, beginning with the first one attended. If you answered "High School" above, you may skip this section and the following section.

First Institution:

Degree Type:

Month and Year You Began Program:

Month and Year of Degree OR of Departure from Program:

Major ("undecided" is acceptable):

Second Institution:

Degree Type:

Month and Year You Began Program:

Month and Year of Degree OR of Departure from Program:

Major ("undecided" is acceptable):

PREVIOUS EDUCATION: GRADUATE

Please list graduate colleges or universities attended prior to your current academic institution, beginning with the first one attended. If you answered "High School" above, you may skip this section and the previous section.

First Institution:

Degree Type:

Month and Year You Began Program:

Month and Year of Degree OR of Departure from Program:

Major ("undecided" is acceptable):

Second Institution:

Degree Type:

Month and Year You Began Program:

Month and Year of Degree OR of Departure from Program:

Major ("undecided" is acceptable):

Third Institution:

Degree Type:

Month and Year You Began Program:

Month and Year of Degree OR of Departure from Program:

Major ("undecided" is acceptable):

ACADEMIC INTERESTS

Limnology
Oceanography

Environmental Specialty

    Rivers and Streams
    Lakes and Reservoirs
    Freshwater Wetlands
    Estuaries
    Open Ocean
    Deep Ocean
    Coastal Ocean
    Marine Wetlands

Disciplinary Specialty

    Biological
    Chemical
    Geological
    Mathematics
    Physical

Disciplinary Subfield
(Select no more than three)

    Fish
    Invertebrates
    Macrophytes
    Phytoplankton
    Vertebrates
    Zooplankton

    Aquaculture
    Atmospheric Sciences
    Biogeochemical Processes
    Ecology
    Fisheries
    Food Webs
    Microbial Ecology/Microbiology
    Modeling
    Nutrient Cycling
    Photosynthesis/Primary Production
    Remote Sensing/Instrumentation
    Secondary Production
    Most or all areas

PREVIOUS PARTICIPATION IN REU AND MINORITIES PROGRAMS

Have you ever participated in a National Science Foundation (NSF) REU Program or NSF Minority Program?

Yes No

If yes, please note the year attended for the appropriate program(s).

Alabama: Dauphin Island Sea Lab., Undergraduate Fellowships for Research in Marine Science:

Alaska: UAS Juneau Campus, Undergraduate Research Experience in Marine Biology:

Bermuda: Bermuda Biological Station for Research, Research Experience for Undergraduates:

Delaware: University of Delaware, Summer Intern Program:

Florida: Florida Tech Summer Internships, Research Experiences for Undergraduates; Science in Support of Coastal Resources:

Florida and Georgia: Savannah State University & Harbor Branch Oceanographic Institution, A bridge to Research in the Marine Sciences:

Hawaii: University of Hawaii, Ocean Research Experience for Undergraduates:

Maine: Darling Marine Center, U. of Maine, Research Experience for Undergraduates (REU) Fellowships:

Maine: Shoales Marine Laboratory, Cornell University, REU Program:

Maryland: University of Maryland, Undergraduate Fellowships in Estuarine Sciences:

Massachusetts: Woods Hole Oceanographic Institution, Summer Student Fellowship Program:

Mississippi: University of Southern Mississippi-Jackson State University, Research Experience in Coastal and Marine Sciences Summer Program for Underrepresented Minorities:

New York: Columbia University at Lamont-Doherty Earth Observatory Summer Internship Program for Undergraduates:

New York: State University of New York Stony Brook, Summer Undergraduate Research Fellowships in Estuarine Processes:

Oregon: Oregon State University, Native Americans in Marine Science (NAMS):

Rhode Island: University of Rhode Island, Summer Undergraduate Research Fellowships in Oceanography (SURFO):

South Carolina: South Carolina Department of Natural Resources, Marine Resources Division Minority Training Internship Program:

Virginia: Virginia Institute of Marine Science Summer Intern Program (SIP):

Virginia: Old Dominion University, Minority Undergraduate Scholarship and Training (MUST):

Virginia: Hampton University and ASLO, Expanding Linkages between Under-Represented Minorities and Careers in Aquatic Sciences (if you were supported for more than one meeting, check here and select the MOST RECENT year you were supported):

Washington: Western Washington University, Shannon Point Marine Center (SPMC), Research for Undergraduates:

Washington: Western Washington University, Minorities in Marine Science Undergraduate Program (MIMSUP):

Wisconsin: University of Wisconsin-Milwaukee, Center for Great Lakes Studies Summer Internships in Aquatic Sciences:

OTHER SUMMER RESEARCH PROGRAMS ATTENDED

Have you ever attended another summer research program in the aquatic sciences (other than the ones listed above)?

Yes No

PROGRAM NAME	YEAR(S)

STATEMENT OF INTEREST

This section should only be filled out if you choose to be included in the online Student Directory. Information in this statement will be displayed in a publically searchable web page along with your full name, e-mail, current academic information, and field(s) of interest from the form questions above. Please provide a concise description of your academic and professional interests in the aquatic sciences, your academic and career goals, and current and past activities related to your interests and goals. This should include a description of any coursework or research experience you have completed, a description of any relevant job experience you have had, and the citations for any published or presented papers.

General Guidelines

Your entry must fit in a space no larger than 6.5” x 9” using Times 12 font.
Format the message so that it appears within the text box as you wish it to appear on the page. Please note, however, that complex formatting (e.g., two columns, indentations for than one space, superscripts, subscripts and some special characters) will be lost.
Break paragraphs using the Enter or Return key, leaving a single blank line between paragraphs.
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Minority Student Database and Online Directory Form

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