Applications should be mailed to Hughes Summer Outreach Program, MB&B Department, Wesleyan University, Middletown, CT 06459 by March 10. Please have 2 letters of recommendation from faculty and a current transcript submitted by that same date. Awards will be announced by April 11.

1. Name_____________________________________

2. Class: frosh / soph / junior  (circle one)

3. Major_____________________________________

4. University_________________________________

5. Email address______________________________

6. Phone Number_____________________________

7. Soc. Sec. Number_____________________

8. Home address__________________________________________________

9. Are you a citizen of the US?_______ If not, do you have a green card?_________

10. Letters of recommendation will be from:

(i)________________________________________

(ii)_______________________________________

11. On a separate sheet, please describe:

(i) any previous research experience and source of support

(ii) your research interests

(iii) how a summer research experience would relate to your academic and profession goals

Signature______________________________________