AGEP Undergraduate Fellows Application

Questions marked with an asterisk (*) are mandatory.
1
* Full Name
Last :
First:
Middle:
Suffix:
2
* Phone Number (area code first)
3
* Preferred Email Address
4
* Local Address
Street Address:
Apartment #:
City/Town:
Zip Code:
5
* Permanent Address
Street Address:
Apartment #:
City/Town:
State:
Zip Code:
6
* Name of Parents or Guardians
7
* Parent/Guardian Phone Number (area code first)
8
* Major
9
2nd Major (if applicable)
10
* Academic Advisor
11
* Academic Class Year
12
* Expected Graduation Year
13
* Credit Hours Completed to Date
14
* Cumulative GPA
15
* Gender:
Male
Female
16
* Ethnicity
Black/African American
Hispanic/Latino
American Indian
Alaska Native
Pacific Islander
Other, please specify
17
* Citizenship
US Citizen or Permanent VISA
Non-US Citizen (please indicate citizenship)
18
* Please list the degree(s) you hope to attain and your career goals.
19
* Please list the area(s) in which you would like to do research
20
* Is there a specific UNC faculty member(s) with whom you would like to conduct research?
If yes, please list faculty name & department
21
* Have you spoken with the faculty member regarding the possibility of you doing research under his/her direction?
22
* Is the faculty member willing to allow you to work under his/her direction?
If you answered yes to question 22, please have the faculty member provide a brief description of the research project and a statement indicating that he/she is willing to oversee your research involvement. Please send via campus mail or email this information to Kathy Wood, Executive Program Manager, at kathy_wood@unc.edu or CB#3290.
23
* Your electronic signature that all above information is accurate and complete is entering your PID number here.