DOC SURF Application - ACS Division of Organic Chemistry



Summer Undergraduate Research FellowshipORGANIC CHEMISTRYStudent Application Cover SheetName:Institution:Research Title:Department (Major):Expected Graduation (MM/YYYY):Student’s ACS #:Student’s Complete Campus Mail Delivery Address:Student’s Phone NumberStudent’s Email Address:For details on the application requirements, see Undergraduate Research FellowshipORGANIC CHEMISTRYFaculty Mentor Cover SheetFaculty Mentor:Academic Title:ACS Member #:Complete Campus Mail Delivery Address:Phone Number:Email Address:For details on the application requirements, see Undergraduate Research FellowshipORGANIC CHEMISTRYDepartment Chair/Head Cover SheetChair Name:Academic Title:Complete Campus Mail Delivery Address:Phone NumberStudent Nominee:Please submit a letter, indicating that the student is a departmental nominee (there may be no more than 2 nominees per department, and no more than 1 nominee per research group) and the department will provide the necessary equipment, space, and administrative support to the project. If the department nominates two students, please include a copy of your letter with each application submitted.In the event the faculty mentor is also the department chair, then the faculty member’s immediate supervisor should complete this form.We are asking for the Department Chair’s address so that upon award we know where to send the award check.The completed nomination must be submitted to the Division of Organic Chemistry SURF Program through the Division of Organic Chemistry’s website by the Student’s Faculty Research Mentor. For details on the application requirements, see ................
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